Provider Demographics
NPI:1851460430
Name:DAVID AND DEANNE WITHERSPOON, OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:DAVID AND DEANNE WITHERSPOON, OPTOMETRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-464-9702
Mailing Address - Street 1:5212 VILLAGE PKWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8104
Mailing Address - Country:US
Mailing Address - Phone:479-464-9702
Mailing Address - Fax:
Practice Address - Street 1:5212 VILLAGE PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8104
Practice Address - Country:US
Practice Address - Phone:479-464-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty