Healthcare Provider Details

I. General information

NPI: 1245101427
Provider Name (Legal Business Name): HSD MANAGEMENT OF HOT SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 CENTRAL AVE STE A
HOT SPRINGS AR
71913-7341
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 501-276-2020
  • Fax: 201-525-5080
Mailing address:
  • Phone: 501-276-2020
  • Fax: 501-525-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CALEB TANCK
Title or Position: INSURANCE MANAGER
Credential:
Phone: 539-476-2015