Provider Demographics
NPI:1578676557
Name:RONALD A BURKS OD PA
Entity Type:Organization
Organization Name:RONALD A BURKS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-676-5100
Mailing Address - Street 1:1300 N CENTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-2011
Mailing Address - Country:US
Mailing Address - Phone:501-676-5100
Mailing Address - Fax:501-676-5015
Practice Address - Street 1:1300 N CENTER ST
Practice Address - Street 2:STE A
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2011
Practice Address - Country:US
Practice Address - Phone:501-676-5100
Practice Address - Fax:501-676-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B171OtherAR BLUE CROSS BLUE SHIELD
ARDG3692OtherRAILROAD MEDICARE
ARDG3692OtherRAILROAD MEDICARE
AR0179280002Medicare NSC