Provider Demographics
NPI:1457316002
Name:SMALLING, ROBERT W (OD, PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SMALLING
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:119 NORTH MAIN STREET
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-0420
Mailing Address - Country:US
Mailing Address - Phone:870-226-6731
Mailing Address - Fax:870-226-7894
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2714
Practice Address - Country:US
Practice Address - Phone:870-226-6731
Practice Address - Fax:870-226-7894
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110204722Medicaid
AR48960Medicare ID - Type Unspecified
T20256Medicare UPIN