Provider Demographics
NPI:1043355506
Name:BUELL, BRIAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:BUELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4083 N SHILOH DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5300
Mailing Address - Country:US
Mailing Address - Phone:479-521-7774
Mailing Address - Fax:479-521-4928
Practice Address - Street 1:4083 N SHILOH DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5300
Practice Address - Country:US
Practice Address - Phone:479-521-7774
Practice Address - Fax:479-521-4928
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20247Medicare UPIN