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General NPI Number Information
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NPI Number | 1417765488
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Entity Type | Organization
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Legal Business Name | CENTRAL ARKANSAS LASIK
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 220 N VAN BUREN ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3650
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Country | US
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Telephone | 501-712-5200
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Fax | 501-353-1221
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Provider Business Mailing Address
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Address Line | 1900 SHADOW LN
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City | LITTLE ROCK
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State | AR
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Zip | 72207-2018
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Country | US
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Telephone | 501-554-6112
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Fax |
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Authorized Official
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Title or Position | OPHTHALMOLOGIST/LASIK SURGEON
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Name | DR. EDWARD M. PENICK III
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Credential | M.D.
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Telephone | 501-712-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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