Provider Demographics
NPI:1790754471
Name:JAMES, BRENT A (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:JAMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 24063
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-4063
Mailing Address - Country:US
Mailing Address - Phone:501-773-0312
Mailing Address - Fax:501-325-0355
Practice Address - Street 1:28 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2909
Practice Address - Country:US
Practice Address - Phone:501-773-0312
Practice Address - Fax:501-325-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200119722Medicaid
AR6020670001Medicare NSC
AR49743Medicare PIN
AR5C877Medicare PIN
ARU74975Medicare UPIN