Healthcare Provider Details

I. General information

NPI: 1912949785
Provider Name (Legal Business Name): PLEASANT VALLEY OPHTHALMOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 HINSON RD STE. 103
LITTLE ROCK AR
72212-3404
US

IV. Provider business mailing address

11825 HINSON RD STE. 103
LITTLE ROCK AR
72212-3404
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-3937
  • Fax: 501-223-8656
Mailing address:
  • Phone: 501-223-3937
  • Fax: 501-223-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN DIANE BLAIR
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 501-223-3937