Provider Demographics
NPI:1609012053
Name:BURROW, LONNIE E (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:E
Last Name:BURROW
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 R ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4417
Mailing Address - Country:US
Mailing Address - Phone:501-664-9350
Mailing Address - Fax:501-661-9732
Practice Address - Street 1:5909 R ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-4417
Practice Address - Country:US
Practice Address - Phone:501-664-9350
Practice Address - Fax:501-661-9732
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-015156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician