Provider Demographics
NPI:1598836066
Name:RAY, RICK D (OD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:RAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-0295
Mailing Address - Country:US
Mailing Address - Phone:479-675-3451
Mailing Address - Fax:479-675-3607
Practice Address - Street 1:2 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-0295
Practice Address - Country:US
Practice Address - Phone:479-675-3451
Practice Address - Fax:479-675-3607
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2267152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49140Medicare ID - Type Unspecified
AR0214260001Medicare NSC