Provider Demographics
NPI:1982798997
Name:SQUIRES, MARIBETH (OD)
Entity type:Individual
Prefix:DR
First Name:MARIBETH
Middle Name:
Last Name:SQUIRES
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616
Mailing Address - Country:US
Mailing Address - Phone:870-423-2576
Mailing Address - Fax:870-423-6750
Practice Address - Street 1:105 S. SPRINGFIELD ST.
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616
Practice Address - Country:US
Practice Address - Phone:870-423-2576
Practice Address - Fax:870-423-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU30688Medicare UPIN
AR48495Medicare ID - Type Unspecified