Healthcare Provider Details

I. General information

NPI: 1467698779
Provider Name (Legal Business Name): FLETCHER BAUGH O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N MAIN ST
ENGLAND AR
72046-1878
US

IV. Provider business mailing address

218 N MAIN ST
ENGLAND AR
72046-1878
US

V. Phone/Fax

Practice location:
  • Phone: 501-842-2276
  • Fax: 870-535-0167
Mailing address:
  • Phone: 501-842-2276
  • Fax: 870-535-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2009
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2009
License Number StateAR

VIII. Authorized Official

Name: DR. FLETCHER BAUGH
Title or Position: OWNER
Credential: O.D.
Phone: 501-842-2276