MEDICARE: RICKY DALE MEADOR OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2348	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972542579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY DALE MEADOR OD

Provider Business Mailing Address
First Line	:	2524 CRESTWOOD RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7623
Country	:	US
Telephone Number	:	501-753-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 CRESTWOOD RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7623
Country	:	US
Telephone Number	:	501-753-2030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/18/2014

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Directions to “ RICKY DALE MEADOR OD” Practice Location

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