Provider Demographics
NPI:1346426152
Name:HERMAN H GINGER, OD,PA
Entity Type:Organization
Organization Name:HERMAN H GINGER, OD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-535-7690
Mailing Address - Street 1:2701 S HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5000
Mailing Address - Country:US
Mailing Address - Phone:870-535-7690
Mailing Address - Fax:870-535-3599
Practice Address - Street 1:2701 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5000
Practice Address - Country:US
Practice Address - Phone:870-535-7690
Practice Address - Fax:870-535-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2070PC014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184988722Medicaid
ARDQ4360OtherRRB
0196630001Medicare NSC