Organization · NPI-2

Alloplastic Reconstruction

Technician/Technologist, Ocularist · Little Rock, AR

NPI number1598049744

StatusActive

Last updated in NPPESSep 26, 2018

Details

NPI: 1598049744
Entity type: Organization (NPI-2)
Legal business name: Alloplastic Reconstruction
Organization subpart: No
Enumeration date: Oct 6, 2011
Last updated: Sep 26, 2018

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
156FX1700X	Technician/Technologist, Ocularist	–	–	Yes
229N00000X	Anaplastologist	–	–
332BC3200X	Durable Medical Equipment & Medical Supplies, Customized Equipment	–	–
174400000X	Specialist	–	–
335E00000X	Prosthetic/Orthotic Supplier	OPP00038	AR

Practice location

3924 W Markham St
Little Rock, AR 72205-5528

Phone 501-265-0100 · Fax 501-265-0102

Mailing address

3924 W Markham St
Little Rock, AR 72205-5528

Phone 501-265-0100 · Fax 501-265-0102

Authorized official

Michael Kaczkowski
President
5012650100

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