Provider Demographics
NPI:1316908213
Name:TAYLOR, JIM ELDREN (OPTOMETRIST OD)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:ELDREN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OPTOMETRIST OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 STEGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132
Mailing Address - Country:US
Mailing Address - Phone:501-397-5596
Mailing Address - Fax:501-397-5596
Practice Address - Street 1:4284 STEGECOACH RD
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132
Practice Address - Country:US
Practice Address - Phone:501-397-5596
Practice Address - Fax:501-397-5596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2192152W00000X
AROP1100024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2192OtherARKANSAS OPTOMETRY
AROP1100024OtherARKANSAS OPTOMETRY
AR49171Medicare ID - Type Unspecified
AR2192OtherARKANSAS OPTOMETRY