Organization
PROGRESSIVE EYE CENTER OF PIGGOTT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY HERMAN ELLIS OD (PRESIDENT)
(870) 598-2625
Entity
Organization
Contact information
Practice address
325 W JACKSON ST, PIGGOTT, AR 72454-2014
(870) 598-2625
(870) 598-5676
Mailing address
PO BOX 740, ASH FLAT, AR 72513-0740
(870) 598-2625
(870) 598-5676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2408
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083776611
NPI
—
01
—
1770897076
NPI
—
Enumeration date
09/15/2010
Last updated
09/15/2010
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