Provider Demographics
NPI:1366731002
Name:MORGAN VISION CLINIC
Entity type:Organization
Organization Name:MORGAN VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TASKER
Authorized Official - Middle Name:N
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:501-843-7511
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2944
Mailing Address - Country:US
Mailing Address - Phone:501-843-7511
Mailing Address - Fax:501-941-2020
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2944
Practice Address - Country:US
Practice Address - Phone:501-843-7511
Practice Address - Fax:501-941-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty