Individual
DR. KENNETH C CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
611 S MOUNT OLIVE ST, SILOAM SPRINGS, AR 72761-3603
(479) 524-4231
(479) 524-8850
Mailing address
PO BOX 159, SILOAM SPRINGS, AR 72761-0159
(479) 524-4231
(479) 524-8850
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2039
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139158722
—
AR
Enumeration date
12/20/2005
Last updated
06/02/2008
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