Provider Demographics
NPI:1487033759
Name:DILLARD, CASEY ROYCE (OD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ROYCE
Last Name:DILLARD
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 1:467460 E 1070 RD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-7116
Mailing Address - Country:US
Mailing Address - Phone:918-208-7257
Mailing Address - Fax:
Practice Address - Street 1:4189 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6013
Practice Address - Country:US
Practice Address - Phone:479-434-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist