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General NPI Number Information
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NPI Number | 1467698779
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Entity Type | Organization
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Legal Business Name | FLETCHER BAUGH O.D.
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 218 N MAIN ST
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City | ENGLAND
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State | AR
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Zip | 72046-1878
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Country | US
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Telephone | 501-842-2276
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Fax | 870-535-0167
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Provider Business Mailing Address
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Address Line | 218 N MAIN ST
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City | ENGLAND
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State | AR
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Zip | 72046-1878
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Country | US
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Telephone | 501-842-2276
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Fax | 870-535-0167
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Authorized Official
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Title or Position | OWNER
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Name | DR. FLETCHER BAUGH
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Credential | O.D.
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Telephone | 501-842-2276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2009
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2009
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License Number State | AR
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