Organization
ALAN L LATOURETTE ESTATE VICKI C LATOURETTE EX
Active
Other names
Tri State Optical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI C LATOURETTE (EXECUTRIX OF ALAN LATOURETTE ESTATE)
(479) 636-2012
Entity
Organization
Contact information
Practice address
1401 W WALNUT ST, ROGERS, AR 72756-3317
(479) 636-2012
(479) 631-7416
Mailing address
1401 W WALNUT ST, ROGERS, AR 72756-3317
(479) 636-2012
(479) 631-7416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185799722
—
AR
Enumeration date
09/30/2010
Last updated
03/29/2011
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