Provider Demographics
NPI:1093988404
Name:RETINA SPECIALISTS OF ARKANSAS, P.A.
Entity type:Organization
Organization Name:RETINA SPECIALISTS OF ARKANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-978-5500
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5416
Mailing Address - Country:US
Mailing Address - Phone:501-978-5500
Mailing Address - Fax:501-978-5550
Practice Address - Street 1:5 SAINT VINCENT CIR STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5416
Practice Address - Country:US
Practice Address - Phone:501-978-5500
Practice Address - Fax:501-978-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117755001Medicaid
ARE67009Medicare UPIN
AR53690Medicare PIN