Provider Demographics
NPI:1154822542
Name:SENIORWORKS OPTOMETRY LLC
Entity Type:Organization
Organization Name:SENIORWORKS OPTOMETRY LLC
Other - Org Name:SENIORWORKS OPTOMETRY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-821-4300
Mailing Address - Street 1:110 W COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5848
Mailing Address - Country:US
Mailing Address - Phone:501-821-4300
Mailing Address - Fax:501-821-4300
Practice Address - Street 1:110 W COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5848
Practice Address - Country:US
Practice Address - Phone:501-821-4300
Practice Address - Fax:501-821-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty