Deitrick, Chris E

Deitrick, Chris E is an sole proprietor health care provider with primary practice located at 101 Case Commons Dr. , Mountain View AR 72560. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Deitrick, Chris E can be contacted via phone (870) 269-3610.

Contact Information

Primary practice address
101 Case Commons Dr. Mountain View AR 72560
Phone: (870) 269-3610
Fax: (870) 269-5086
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 2516 Arkansas
Eye and Vision Services Providers / Optometrist 152W00000X 2516 Arkansas

Profile Details

NPI number 1669470183
LBN Legal business name Deitrick, Chris E
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 8th, 2005
Last updated Aug 14th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669470183 NPPES
Arkansas Other 431988740 TAX ID #
Arkansas MEDICAID 145299722 TAX ID #
Arkansas Other 4709560001 TAX ID #
Arkansas Other 19930000041 TAX ID #
Arkansas Other 410049416 TAX ID #

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