Provider Demographics
NPI:1336300730
Name:SCHROEDER OPTICAL
Entity Type:Organization
Organization Name:SCHROEDER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-4484
Mailing Address - Street 1:9600 LILE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6373
Mailing Address - Country:US
Mailing Address - Phone:501-224-4484
Mailing Address - Fax:501-221-3031
Practice Address - Street 1:9600 LILE DR STE 260
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6373
Practice Address - Country:US
Practice Address - Phone:501-224-4484
Practice Address - Fax:501-221-3031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE SCHROEDER, M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR1935332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104633001Medicaid
AR104633001Medicaid
AR0747830001Medicare NSC