Individual
DR. WAYNE PROVINES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
314 MDG/SGO, 1090 ARNOLD DR, LITTLE ROCK AFB, AR 72099-0001
(501) 987-8702
Mailing address
2812 GRAY FOX LN, JACKSONVILLE, AR 72076-2629
(501) 985-1185
Taxonomy
Speciality
Code
Description
License number
State
152WX0102X
Occupational Vision Optometrist
Primary
9256
AR
Other
Enumeration date
04/10/2006
Last updated
07/08/2007
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