Provider Demographics
NPI:1265424709
Name:BLYTHE, CARL D (OD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:D
Last Name:BLYTHE
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 1:4450 E MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2519
Mailing Address - Country:US
Mailing Address - Phone:501-945-3460
Mailing Address - Fax:501-945-4076
Practice Address - Street 1:4450 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2519
Practice Address - Country:US
Practice Address - Phone:501-945-3460
Practice Address - Fax:501-945-4076
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU00881Medicare UPIN
AR47595Medicare PIN