1285785071 NPI number — JOE HORTON FAMILY EYE CARE, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285785071 NPI number — JOE HORTON FAMILY EYE CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOE HORTON FAMILY EYE CARE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285785071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3061 MARKET AVENUE
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-521-6460
Provider Business Mailing Address Fax Number:
479-442-3493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3061 MARKET AVENUE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-521-6460
Provider Business Practice Location Address Fax Number:
479-442-3493
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
JOE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OPTOMETRIC PHYSICIAN
Authorized Official Telephone Number:
479-521-6460

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2091 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5B439 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 114623722 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285785071 . This is a "MEDICARE GROUP NPI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: CG4273 . This is a "RR MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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