Provider Demographics
NPI:1689682957
Name:EPPERSON, EDDIE SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:SCOTT
Last Name:EPPERSON
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 1:608 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3121
Mailing Address - Country:US
Mailing Address - Phone:870-234-6241
Mailing Address - Fax:870-234-3771
Practice Address - Street 1:608 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3121
Practice Address - Country:US
Practice Address - Phone:870-234-6241
Practice Address - Fax:870-234-3771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5994T152W00000X
ARAR2327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057FAOtherBCBS OF TEXAS
AR410011307OtherRAIL ROAD MEDICARE
AR4T023Medicare UPIN
AR4T023Medicare PIN
AR0818320001Medicare NSC
AR410011307OtherRAIL ROAD MEDICARE