Provider Demographics
NPI:1437710373
Name:BURROUGHS, ZACHARY R (OD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:R
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6115
Mailing Address - Country:US
Mailing Address - Phone:870-476-9372
Mailing Address - Fax:
Practice Address - Street 1:4120 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2531
Practice Address - Country:US
Practice Address - Phone:501-223-2020
Practice Address - Fax:501-801-2741
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty