Provider Demographics
NPI:1477630242
Name:BAUGH EYECARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:BAUGH EYECARE ASSOCIATES, PA
Other - Org Name:BAUGH EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-535-0151
Mailing Address - Street 1:3116 SOUTH OLIVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603
Mailing Address - Country:US
Mailing Address - Phone:870-535-0151
Mailing Address - Fax:870-535-0167
Practice Address - Street 1:3116 SOUTH OLIVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-535-0151
Practice Address - Fax:870-535-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR24202009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126868722Medicaid
AR188368722Medicaid
AR188368722Medicaid
AR0296190001Medicare NSC
AR6769730001Medicare NSC