Individual
MR. JOHN BRADLEY WITHERSPOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1155 HWY 65 NORTH, CONWAY, AR 72032
(501) 328-9500
(501) 328-5148
Mailing address
1155 HWY 65 NORTH, CONWAY, AR 72032
(501) 328-9500
(501) 328-5148
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2272
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106399722
—
AR
Enumeration date
08/19/2005
Last updated
08/09/2010
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