Provider Demographics
NPI:1588025191
Name:LITTLE ROCK EYE CLINIC, LLP
Entity Type:Organization
Organization Name:LITTLE ROCK EYE CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-5658
Mailing Address - Street 1:201 EXECUTIVE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:4104 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2652
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE ROCK EYE CLINIC, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-09
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty