| Organization Name: | MOULTON OPTICAL DEPARTMENT LLC |
| NPI Number: | 1235304924 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EVERETT CROCKETT MOULTON (PRESIDENT) |
| Mailing Address: | 5518 Ellsworth Rd Fort Smith |
| State: | AR US |
| Postal Code: | 729033222 |
| Phone Number: | 4796463937 |
| Fax Number: | 4796463605 |
| NPI Enumeration Date: | 04/24/2008 |
| NPI Last Update Date: | 05/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | C4990 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |