Provider Demographics
NPI:1760425854
Name:BAUGH, STEPHEN LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:BAUGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-3235
Mailing Address - Country:US
Mailing Address - Phone:501-676-6844
Mailing Address - Fax:501-676-3910
Practice Address - Street 1:114 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3235
Practice Address - Country:US
Practice Address - Phone:501-676-6844
Practice Address - Fax:501-676-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2420207W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123812722Medicaid
AR15531000042OtherQUALCHOICE
5555041OtherAETNA
AR123712622Medicaid
410043619OtherRR MEDICARE
15531000041OtherQUALCHOICE
5555041OtherAETNA
15531000041OtherQUALCHOICE
AR123712622Medicaid