Provider Demographics
NPI:1487915963
Name:BYERS, ALICIA ELLEN (OD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELLEN
Last Name:BYERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ELLEN
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 W. P. MALONE ROAD
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5210
Mailing Address - Country:US
Mailing Address - Phone:870-246-6877
Mailing Address - Fax:870-245-0088
Practice Address - Street 1:109 W. P. MALONE ROAD
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5210
Practice Address - Country:US
Practice Address - Phone:870-246-6877
Practice Address - Fax:870-245-0088
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I417003Medicare PIN