=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881766251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTORS PARK EYE CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9600 BAPTIST HEALTH DR SUITE 230
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-6326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-227-6797
-----------------------------------------------------
Fax | 501-228-6336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9600 HEALTH PARK DR SUITE 230
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-6326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-227-6797
-----------------------------------------------------
Fax | 501-228-6336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THOMAS H MOSELEY JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 501-227-6797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------