Provider Demographics
NPI:1699875401
Name:ASHLEY, BRYANT B JR (OD)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:B
Last Name:ASHLEY
Suffix:JR
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 1:3418 CAMP ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5051
Mailing Address - Country:US
Mailing Address - Phone:501-758-1015
Mailing Address - Fax:501-758-1554
Practice Address - Street 1:3418 CAMP ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5051
Practice Address - Country:US
Practice Address - Phone:501-758-1015
Practice Address - Fax:501-758-1554
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105387722Medicaid
AR105387722Medicaid
AR48415Medicare ID - Type Unspecified