Provider Demographics
NPI:1942381587
Name:DR. BRYANT ASHLEY, JR.
Entity Type:Organization
Organization Name:DR. BRYANT ASHLEY, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:501-758-1015
Mailing Address - Street 1:3418 CAMP ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5051
Mailing Address - Country:US
Mailing Address - Phone:501-758-1015
Mailing Address - Fax:501-758-1554
Practice Address - Street 1:3418 CAMP ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5051
Practice Address - Country:US
Practice Address - Phone:501-758-1015
Practice Address - Fax:501-758-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU25081Medicare UPIN
AR0595550001Medicare NSC
AR5B163Medicare PIN