Provider Demographics
NPI:1609963941
Name:MCCALL, LARRY E
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:MCCALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5204
Mailing Address - Country:US
Mailing Address - Phone:501-268-3149
Mailing Address - Fax:501-268-9583
Practice Address - Street 1:506 W ARCH AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5204
Practice Address - Country:US
Practice Address - Phone:501-268-3149
Practice Address - Fax:501-268-9583
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106510722Medicaid
AR48116Medicare PIN
AR0376000001Medicare NSC