Provider Demographics
NPI:1467696518
Name:LIVENGOOD, KEVIN ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLEN
Last Name:LIVENGOOD
Suffix:
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 1:3900 MCCAIN PARK DR
Mailing Address - Street 2:154
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7887
Mailing Address - Country:US
Mailing Address - Phone:319-329-4299
Mailing Address - Fax:
Practice Address - Street 1:291 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4462
Practice Address - Country:US
Practice Address - Phone:501-982-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR2627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program