Provider Demographics
NPI:1891760773
Name:ERGLE, CHEVRON L (OD)
Entity Type:Individual
Prefix:
First Name:CHEVRON
Middle Name:L
Last Name:ERGLE
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 1:521 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3749
Mailing Address - Country:US
Mailing Address - Phone:501-985-0616
Mailing Address - Fax:501-985-0715
Practice Address - Street 1:521 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3749
Practice Address - Country:US
Practice Address - Phone:501-985-0616
Practice Address - Fax:501-985-0715
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154879722Medicaid
ARV01416Medicare UPIN
AR49888Medicare ID - Type Unspecified