Provider Demographics
NPI:1922017482
Name:WITHERSPOON, DEANNE F (OD)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:F
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 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:479-464-9706
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:479-464-9706
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist