Provider Demographics
NPI:1740452887
Name:ALAN L. LATOURETTE ,O.D.
Entity type:Organization
Organization Name:ALAN L. LATOURETTE ,O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LATOURETTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-636-2012
Mailing Address - Street 1:1401 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3317
Mailing Address - Country:US
Mailing Address - Phone:479-636-2012
Mailing Address - Fax:479-631-7416
Practice Address - Street 1:1401 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3317
Practice Address - Country:US
Practice Address - Phone:479-636-2012
Practice Address - Fax:479-631-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0374820001Medicare NSC
T20303Medicare UPIN
49358Medicare PIN