Provider Demographics
NPI:1306806609
Name:STUCKEY, JOHN E II (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:STUCKEY
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:E
Other - Last Name:STUCKEY
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9600 LILE DR
Mailing Address - Street 2:230 DOCTORS PARK BUILDING
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6326
Mailing Address - Country:US
Mailing Address - Phone:501-227-6797
Mailing Address - Fax:501-228-6336
Practice Address - Street 1:9600 LILE DR
Practice Address - Street 2:230 DOCTORS PARK BUILDING
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-227-6797
Practice Address - Fax:501-228-6336
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105025722Medicaid
AR49302Medicare ID - Type Unspecified
AR105025722Medicaid