Provider Demographics
NPI:1881766251
Name:DOCTORS PARK EYE CLINIC PLLC
Entity type:Organization
Organization Name:DOCTORS PARK EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:501-227-6797
Mailing Address - Street 1:9600 HEALTH PARK DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6326
Mailing Address - Country:US
Mailing Address - Phone:501-227-6797
Mailing Address - Fax:501-228-6336
Practice Address - Street 1:9600 BAPTIST HEALTH DR
Practice Address - Street 2:SUITE 230
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-227-6797
Practice Address - Fax:501-228-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B776Medicare ID - Type Unspecified