Individual
JESSICA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4189 PHOENIX AVE STE B, FORT SMITH, AR 72903-6013
(479) 434-4668
Mailing address
389 ROCK ST APT 105, TONTITOWN, AR 72762-4395
(501) 762-7910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2828
AR
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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