Provider Demographics
NPI:1295716439
Name:DAVID L. EVANS, O.D., P.A.
Entity type:Organization
Organization Name:DAVID L. EVANS, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-562-2297
Mailing Address - Street 1:3700 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-6018
Mailing Address - Country:US
Mailing Address - Phone:501-562-2297
Mailing Address - Fax:501-562-6354
Practice Address - Street 1:3700 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-6018
Practice Address - Country:US
Practice Address - Phone:501-562-2297
Practice Address - Fax:501-562-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-06
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105175722Medicaid
AR105175722Medicaid
AR0309020001Medicare NSC
AR49378Medicare ID - Type Unspecified