Healthcare Provider Details

I. General information

NPI: 1376582817
Provider Name (Legal Business Name): ROGER PATRICK NEAL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 CRESTWOOD RD
NORTH LITTLE ROCK AR
72116-7623
US

IV. Provider business mailing address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-3050
  • Fax: 501-758-5052
Mailing address:
  • Phone: 501-758-3050
  • Fax: 501-758-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2316
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: