Provider Demographics
NPI:1417479452
Name:CORA, GEORGE C (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:CORA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:CORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11225 HURON LN STE 200A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1861
Mailing Address - Country:US
Mailing Address - Phone:501-332-6262
Mailing Address - Fax:501-337-0373
Practice Address - Street 1:1023 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5222
Practice Address - Country:US
Practice Address - Phone:501-332-6262
Practice Address - Fax:501-337-0373
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS968152W00000X
AR2779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232049722Medicaid