Healthcare Provider Details

I. General information

NPI: 1982667051
Provider Name (Legal Business Name): ARKANSAS OPHTHALMOLOGY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MCAULEY CT
HOT SPRINGS AR
71913-6314
US

IV. Provider business mailing address

211 MCAULEY CT
HOT SPRINGS AR
71913-6314
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-0609
  • Fax: 501-624-6191
Mailing address:
  • Phone: 501-624-0609
  • Fax: 501-624-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2248
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC4653
License Number StateAR

VIII. Authorized Official

Name: DR. TOM R WALLACE
Title or Position: OWNER/OPHTHALMOLOGIST
Credential: M.D.
Phone: 501-624-0609