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General NPI Number Information
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NPI Number | 1356483614
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Entity Type | Individual
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Provider Name | WALTER CLARK ANGEL O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 S UNIVERSITY AVE
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5209
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Country | US
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Telephone | 501-664-7217
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Fax | 501-664-3429
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Provider Business Mailing Address
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Address Line | 2913 CHARTER OAK DR
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City | LITTLE ROCK
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State | AR
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Zip | 72227-3007
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Country | US
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Telephone | 501-223-9196
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Fax | 501-664-3429
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AR2005
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License Number State | AR
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