Provider Demographics
NPI:1386859411
Name:LYDIA LANE DWORKIN, M.D. PA
Entity Type:Organization
Organization Name:LYDIA LANE DWORKIN, M.D. PA
Other - Org Name:HOT SPRINGS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HRDLICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-1204
Mailing Address - Street 1:402 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5354
Mailing Address - Country:US
Mailing Address - Phone:501-624-1204
Mailing Address - Fax:501-624-6800
Practice Address - Street 1:402 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5354
Practice Address - Country:US
Practice Address - Phone:501-624-1204
Practice Address - Fax:501-624-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1033112420OtherNPI NUMBER TYPE 1
AR5M908Medicare ID - Type Unspecified
AR1033112420OtherNPI NUMBER TYPE 1