Provider Demographics
NPI:1073564894
Name:FRANKS, JUSTIN BAILEY (OD, )
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BAILEY
Last Name:FRANKS
Suffix:
Gender:M
Credentials:OD,
Other - Prefix:DR
Other - First Name:JUSTIN
Other - Middle Name:BAILEY
Other - Last Name:FRANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, PA
Mailing Address - Street 1:201 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2425
Mailing Address - Country:US
Mailing Address - Phone:870-942-3621
Mailing Address - Fax:870-942-7825
Practice Address - Street 1:201 W HOLLY ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2425
Practice Address - Country:US
Practice Address - Phone:870-942-3621
Practice Address - Fax:870-942-7825
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2535152W00000X
AZOP1100372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152217722Medicaid
ARP00373392OtherRAILROAD MEDICARE PTAN FOR THE SHERIDAN OFFICE
ARP00864852OtherRAILROAD MEDICARE PTAN FOR THE BENTON OFFICE
AR49861Medicare PIN
ARU96794Medicare UPIN