Provider Demographics
NPI:1437471588
Name:DEER OPTICAL
Entity Type:Organization
Organization Name:DEER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:501-224-4359
Mailing Address - Street 1:4942 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3732
Mailing Address - Country:US
Mailing Address - Phone:501-224-4359
Mailing Address - Fax:501-224-1003
Practice Address - Street 1:4942 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3732
Practice Address - Country:US
Practice Address - Phone:501-224-4359
Practice Address - Fax:501-224-1003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEER EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-17
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6369510001Medicare NSC