MEDICARE: ARKANSAS OCULOPLASTIC SURGERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician		AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396852901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS OCULOPLASTIC SURGERY, PLLC

Provider Business Mailing Address
First Line	:	9800 BAPTIST HEALTH DR STE 500
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6243
Country	:	US
Telephone Number	:	501-223-2244
Fax Number	:	501-223-2231

Provider Business Practice Location Address
First Line	:	9800 BAPTIST HEALTH DR STE 500
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6243
Country	:	US
Telephone Number	:	501-223-2244
Fax Number	:	501-223-2231

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	JO ANN MCCORMACK
Credential	:
Telephone Number	:	501-223-2244

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/13/2017

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Directions to “ARKANSAS OCULOPLASTIC SURGERY, PLLC ” Practice Location

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