Healthcare Provider Details

I. General information

NPI: 1205702883
Provider Name (Legal Business Name): NATURAL STATE RETINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 KYLE CT
LITTLE ROCK AR
72212-2907
US

IV. Provider business mailing address

3 KYLE CT
LITTLE ROCK AR
72212-2907
US

V. Phone/Fax

Practice location:
  • Phone: 501-680-2214
  • Fax:
Mailing address:
  • Phone: 501-680-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD T WARE
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 501-680-2214