Provider Demographics
NPI:1538563895
Name:VISION THERAPY CENTER OF JONESBORO, P.L.L.C.
Entity type:Organization
Organization Name:VISION THERAPY CENTER OF JONESBORO, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-336-0387
Mailing Address - Street 1:3705 E JOHNSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1858
Mailing Address - Country:US
Mailing Address - Phone:870-336-0387
Mailing Address - Fax:870-336-2455
Practice Address - Street 1:3705 E JOHNSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1858
Practice Address - Country:US
Practice Address - Phone:870-336-0387
Practice Address - Fax:870-336-2455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION THERAPY CENTER OF JONESBORO, P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2591152WV0400X
AR2628152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty