Healthcare Provider Details

I. General information

NPI: 1275779951
Provider Name (Legal Business Name): STEPHEN L BAUGH OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E FRONT ST
LONOKE AR
72086-3235
US

IV. Provider business mailing address

114 E FRONT ST
LONOKE AR
72086-3235
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-6844
  • Fax: 501-676-3910
Mailing address:
  • Phone: 501-676-6844
  • Fax: 501-676-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberAR2420
License Number StateAR

VIII. Authorized Official

Name: DR. STEPHEN L BAUGH
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 501-676-6844