Provider Demographics
NPI:1912988577
Name:GURLEY, R DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:DEAN
Last Name:GURLEY
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 1:527 N 6TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2407
Mailing Address - Country:US
Mailing Address - Phone:870-762-2297
Mailing Address - Fax:
Practice Address - Street 1:527 N 6TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2407
Practice Address - Country:US
Practice Address - Phone:870-762-2297
Practice Address - Fax:870-763-2552
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163428722Medicaid
AR49240G251Medicare PIN
AR0401390001Medicare NSC
AR163428722Medicaid