Provider Demographics
NPI:1154533776
Name:ROBERT W SMALLING OD PA
Entity type:Organization
Organization Name:ROBERT W SMALLING OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMALLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-226-6731
Mailing Address - Street 1:119 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-2714
Mailing Address - Country:US
Mailing Address - Phone:870-226-6731
Mailing Address - Fax:870-226-7894
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2714
Practice Address - Country:US
Practice Address - Phone:870-226-6731
Practice Address - Fax:870-226-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102194722Medicaid
AR102194722Medicaid
AR0278190001Medicare NSC
ART20256Medicare UPIN