Provider Demographics
NPI:1417765488
Name:CENTRAL ARKANSAS LASIK
Entity type:Organization
Organization Name:CENTRAL ARKANSAS LASIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST/LASIK SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:501-712-5200
Mailing Address - Street 1:1900 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2018
Mailing Address - Country:US
Mailing Address - Phone:501-554-6112
Mailing Address - Fax:
Practice Address - Street 1:220 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3650
Practice Address - Country:US
Practice Address - Phone:501-712-5200
Practice Address - Fax:501-353-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty