Provider Demographics
NPI:1487884813
Name:TOLBERT, AMY MICHELLE (OD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:TOLBERT
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 1:110 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3405
Mailing Address - Country:US
Mailing Address - Phone:870-523-3333
Mailing Address - Fax:
Practice Address - Street 1:110 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3405
Practice Address - Country:US
Practice Address - Phone:870-202-1100
Practice Address - Fax:833-293-2984
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179679722Medicaid
AR2630OtherARKANSAS STATE LISENCURE
AR4M245G139Medicare PIN