Provider Demographics
NPI:1770996845
Name:JARRARD, BLAKE (OD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:JARRARD
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 1:2520 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7623
Mailing Address - Country:US
Mailing Address - Phone:501-758-9500
Mailing Address - Fax:501-753-4311
Practice Address - Street 1:2520 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7623
Practice Address - Country:US
Practice Address - Phone:501-758-9500
Practice Address - Fax:501-753-4311
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2712152W00000X, 152W00000X
OR3674ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist