Organization
JOHN B WITHERSPOON OPTOMETRIC PHYSICIAN LTD
Active
Other names
Conway Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN B WITHERSPOON O.D. (OWNER/PHYSICIAN)
(501) 328-9500
Entity
Organization
Contact information
Practice address
29 RIVER ROAD DR E, MAYFLOWER, AR 72106-8409
(501) 328-9500
(501) 328-5148
Mailing address
1155 HWY 65 NORTH, CONWAY, AR 72032
(501) 328-9500
(501) 328-5148
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2272
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106399722
—
AR
01
—
5G617
MEDICARE PTAN
AR
Enumeration date
09/22/2010
Last updated
10/27/2010
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