Provider Demographics
NPI:1467698779
Name:FLETCHER BAUGH O.D.
Entity Type:Organization
Organization Name:FLETCHER BAUGH O.D.
Other - Org Name:LEWIS FLETCHER BAUGH O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLETCHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-842-2276
Mailing Address - Street 1:218 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-1878
Mailing Address - Country:US
Mailing Address - Phone:501-842-2276
Mailing Address - Fax:870-535-0167
Practice Address - Street 1:218 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLAND
Practice Address - State:AR
Practice Address - Zip Code:72046-1878
Practice Address - Country:US
Practice Address - Phone:501-842-2276
Practice Address - Fax:870-535-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2009152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149325722Medicaid
AR0296190002Medicare NSC