Healthcare Provider Details

I. General information

NPI: 1265920813
Provider Name (Legal Business Name): ALLOPLASTIC RESTORATION FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N VAN BUREN ST
LITTLE ROCK AR
72205-3650
US

IV. Provider business mailing address

220 N VAN BUREN ST
LITTLE ROCK AR
72205-3650
US

V. Phone/Fax

Practice location:
  • Phone: 501-454-4945
  • Fax:
Mailing address:
  • Phone: 501-454-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: LOUIS DANIEL EATON
Title or Position: PRESIDENT
Credential:
Phone: 501-454-4945