Healthcare Provider Details

I. General information

NPI: 1811995368
Provider Name (Legal Business Name): THOMAS H GULLEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 LOUISIANA ST
LITTLE ROCK AR
72201-3702
US

IV. Provider business mailing address

404 LOUISIANA ST
LITTLE ROCK AR
72201-3702
US

V. Phone/Fax

Practice location:
  • Phone: 501-375-8271
  • Fax: 501-375-8272
Mailing address:
  • Phone: 501-375-8271
  • Fax: 501-375-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2075
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: