Provider Demographics
NPI:1467696070
Name:CHARLES F HYMAN O. D.
Entity Type:Organization
Organization Name:CHARLES F HYMAN O. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:870-735-8466
Mailing Address - Street 1:1028 N MISSOURI ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2613
Mailing Address - Country:US
Mailing Address - Phone:870-735-8466
Mailing Address - Fax:870-735-0717
Practice Address - Street 1:1028 N MISSOURI ST
Practice Address - Street 2:STE 1
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2613
Practice Address - Country:US
Practice Address - Phone:870-735-8466
Practice Address - Fax:870-735-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2249332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0463640001Medicare NSC