Provider Demographics
NPI:1811995368
Name:GULLEY, THOMAS H (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:GULLEY
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 1:404 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3702
Mailing Address - Country:US
Mailing Address - Phone:501-375-8271
Mailing Address - Fax:501-375-8272
Practice Address - Street 1:404 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3702
Practice Address - Country:US
Practice Address - Phone:501-375-8271
Practice Address - Fax:501-375-8272
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2075152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0436770001OtherPALMETTO
AR104316722Medicaid
AR2220008OtherUNITED HEALTHCARE
AR17371000040OtherQUAL CHOICE
AR0436770001OtherPALMETTO
ART20143Medicare UPIN