Organization
PLEASANT VALLEY OPHTHALMOLOGY, PLLC
Active
Organization
PLEASANT VALLEY OPHTHALMOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN DIANE BLAIR M.D. (OWNER PHYSICIAN)
(501) 223-3937
Entity
Organization
Contact information
Practice address
11825 HINSON RD, STE. 103, LITTLE ROCK, AR 72212-3404
(501) 223-3937
(501) 223-8656
Mailing address
11825 HINSON RD, STE. 103, LITTLE ROCK, AR 72212-3404
(501) 223-3937
(501) 223-8656
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ3133
RR MEDICARE GROUP #
AR
Enumeration date
06/13/2006
Last updated
10/27/2014
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