Provider Demographics
NPI:1396813945
Name:DEER EYE CLINIC PA
Entity Type:Organization
Organization Name:DEER EYE CLINIC PA
Other - Org Name:DEER PENICK EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-4701
Mailing Address - Street 1:4942 W. MARKHAM
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-4701
Mailing Address - Fax:501-224-1003
Practice Address - Street 1:4942 W. MARKHAM
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-224-4701
Practice Address - Fax:501-224-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
ARR-1735207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111409002Medicaid
AR111409002Medicaid