Provider Demographics
NPI:1346377678
Name:DR. DALE LADD PA
Entity Type:Organization
Organization Name:DR. DALE LADD PA
Other - Org Name:TOWN PLAZA OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-793-6857
Mailing Address - Street 1:1119 N SAINT LOUIS
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9458
Mailing Address - Country:US
Mailing Address - Phone:870-793-6857
Mailing Address - Fax:
Practice Address - Street 1:1119 N SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9458
Practice Address - Country:US
Practice Address - Phone:870-793-6857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127707722Medicaid
AR126161722Medicaid
AR48815OtherBLUECROSSBLUESHEILD