Provider Demographics
NPI:1477643906
Name:DOAN, KENNAN ARTEMUS (OD)
Entity Type:Individual
Prefix:
First Name:KENNAN
Middle Name:ARTEMUS
Last Name:DOAN
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 1:9800 LILE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6230
Mailing Address - Country:US
Mailing Address - Phone:501-225-4488
Mailing Address - Fax:501-225-9299
Practice Address - Street 1:9800 LILE DR STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6230
Practice Address - Country:US
Practice Address - Phone:501-225-4488
Practice Address - Fax:501-225-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20302Medicare UPIN
AR49335Medicare ID - Type Unspecified