Provider Demographics
NPI:1538217229
Name:HUTCHINS, MALCOLM R (OD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:R
Last Name:HUTCHINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 NW MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8088
Mailing Address - Country:US
Mailing Address - Phone:479-430-4406
Mailing Address - Fax:
Practice Address - Street 1:5111 ROGERS AVE
Practice Address - Street 2:SUITE 54
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-452-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1164735981Medicare PIN
AR37660Medicare UPIN
AR48582Medicare ID - Type Unspecified