Provider Demographics
NPI:1518016435
Name:FRESHOUR, PENNY (OD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:
Last Name:FRESHOUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:GRIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:900 S BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3617
Mailing Address - Country:US
Mailing Address - Phone:501-904-5009
Mailing Address - Fax:501-217-8679
Practice Address - Street 1:900 S BOWMAN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3617
Practice Address - Country:US
Practice Address - Phone:501-904-5009
Practice Address - Fax:501-217-8679
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR19983000040OtherQUALCHOICE
ARP00273197OtherRAILROAD MEDICARE
AR135365722Medicaid
ARAR2483OtherAR LICENSE
AR19983000040OtherQUALCHOICE