Individual
THOMAS G JUSTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1023 S MAIN STREET, MALVERN, AR 72104
(501) 332-6262
(501) 337-0373
Mailing address
1023 S MAIN STREET, MALVERN, AR 72104
(501) 332-6262
(501) 337-0373
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2312
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0396990001
DME MAC JURISDICTION C
AR
Enumeration date
08/02/2006
Last updated
12/21/2007
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