Basic Information
| Provider Information | |||||||||
| NPI: | 1780188193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSER | ||||||||
| FirstName: | BROOKE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727031944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794445093 | ||||||||
| FaxNumber: | 4795876105 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 ROGERS AVE FL 5 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729034067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792744400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 9447T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2985 | OK | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2790 | AR | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.