Provider Demographics
NPI:1598793143
Name:IRBY, JARRELL D
Entity Type:Individual
Prefix:
First Name:JARRELL
Middle Name:D
Last Name:IRBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8207
Mailing Address - Country:US
Mailing Address - Phone:870-777-1901
Mailing Address - Fax:870-777-9062
Practice Address - Street 1:108 E 19TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8207
Practice Address - Country:US
Practice Address - Phone:870-777-1901
Practice Address - Fax:870-777-9062
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2284OtherLICENSE
AR102608722Medicaid