Individual
BRYAN SCOTT KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
924 MAIN ST, CONWAY, AR 72032-5424
(501) 327-4444
(501) 327-3962
Mailing address
924 MAIN ST, CONWAY, AR 72032-5424
(501) 327-4444
(501) 327-3962
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2494
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137583722
—
AR
Enumeration date
11/30/2005
Last updated
01/23/2020
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