Individual
SAMUEL L ERWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
609 N MISSOURI AVE, CORNING, AR 72422-1617
(870) 857-6556
(870) 857-3787
Mailing address
PO BOX 37, CORNING, AR 72422-0037
(870) 857-6556
(870) 857-3787
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2293
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101510722
—
AR
01
—
291690
PTAN
AR
Enumeration date
07/28/2006
Last updated
08/23/2013
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