Provider Demographics
NPI:1093814048
Name:MCNAMARA, LARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5857
Mailing Address - Country:US
Mailing Address - Phone:870-972-6040
Mailing Address - Fax:870-972-5337
Practice Address - Street 1:514 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5857
Practice Address - Country:US
Practice Address - Phone:870-972-6040
Practice Address - Fax:870-972-5337
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20180Medicare UPIN
AR48189Medicare ID - Type UnspecifiedMEDICARE