Provider Demographics
NPI:1760808752
Name:BROCK, KINDRA (ABOC, LICENSED OPTIC)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:ABOC, LICENSED OPTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 RANCH DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4538
Mailing Address - Country:US
Mailing Address - Phone:501-200-7442
Mailing Address - Fax:
Practice Address - Street 1:5507 RANCH DR
Practice Address - Street 2:SUITE 207
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4538
Practice Address - Country:US
Practice Address - Phone:501-200-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-120802156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician