Provider Demographics
NPI:1174737365
Name:LITTLE ROCK EYE CLINIC, LLP
Entity type:Organization
Organization Name:LITTLE ROCK EYE CLINIC, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-5658
Mailing Address - Street 1:201 EXECUTIVE CT STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:201 EXECUTIVE CT STE A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4536
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47982OtherARKANSAS BLUE CROSS BLUE