Provider Demographics
NPI:1427033596
Name:HENNESSEY, DANIEL J III (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:HENNESSEY
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EXECUTIVE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:4200 N. RODNEY PARHAM ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:UM
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-687-0801
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110756722Medicaid
AR48867OtherMEDICARE ID-TYPE UNSPECIFIED
AR110756722Medicaid