Provider Demographics
NPI:1255332433
Name:PETTY, MEGAN JO (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JO
Last Name:PETTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JO
Other - Last Name:VONMOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9314
Mailing Address - Country:US
Mailing Address - Phone:479-795-1411
Mailing Address - Fax:479-795-1412
Practice Address - Street 1:101 DAWN DR
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9314
Practice Address - Country:US
Practice Address - Phone:479-426-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2568152WV0400X
OK2462152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy