Healthcare Provider Details

I. General information

NPI: 1578676557
Provider Name (Legal Business Name): RONALD A BURKS OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N CENTER ST STE A
LONOKE AR
72086-2011
US

IV. Provider business mailing address

1300 N CENTER ST SUITE A
LONOKE AR
72086-2011
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-5100
  • Fax: 501-676-5015
Mailing address:
  • Phone: 501-676-5100
  • Fax: 501-676-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2273
License Number StateAR

VIII. Authorized Official

Name: DR. RONALD A BURKS
Title or Position: OWNER
Credential: OD
Phone: 501-676-5100