Organization
GULLEY VISION CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DONNA LOFTIS (OFFICE MANAGER)
(501) 375-8271
Entity
Organization
Contact information
Practice address
404 LOUISIANA ST, LITTLE ROCK, AR 72201-3702
(501) 375-8271
(501) 375-8272
Mailing address
404 LOUISIANA ST, LITTLE ROCK, AR 72201-3702
(501) 375-8271
(501) 375-8272
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2075
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104316722
—
AR
01
—
47930
MEDICARE PROVIDER NUMBER
AR
Enumeration date
12/07/2010
Last updated
07/01/2022
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