Individual
TRACI L WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
104 W COLT SQUARE DR, SUITE 2, FAYETTEVILLE, AR 72703-2834
(479) 251-9482
Mailing address
104 W COLT SQUARE DR, SUITE 2, FAYETTEVILLE, AR 72703-2834
(479) 251-9482
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
L-920822
AR
Other
Enumeration date
06/19/2008
Last updated
06/19/2008
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