Provider Demographics
NPI:1255567657
Name:HULL, ROBYN JEANETTE (OD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:JEANETTE
Last Name:HULL
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 1:129 N WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9162
Mailing Address - Country:US
Mailing Address - Phone:479-856-9344
Mailing Address - Fax:
Practice Address - Street 1:1250 S AMITY RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8732
Practice Address - Country:US
Practice Address - Phone:501-575-6230
Practice Address - Fax:501-575-6249
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR207760722Medicaid