1386737021 NPI number — ARKANSAS OUTPATIENT EYE SURGERY LLC

Table of content: (NPI 1386737021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386737021 NPI number — ARKANSAS OUTPATIENT EYE SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS OUTPATIENT EYE SURGERY LLC
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:
MCDONALD EYE ASSOCIATES SURGERY AND LASIK CENTER
Provider Other Organization Name Type Code:
5
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:
1386737021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3689 N STEELE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-249-6006
Provider Business Mailing Address Fax Number:
479-287-4294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3689 N STEELE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-249-6006
Provider Business Practice Location Address Fax Number:
479-287-4294
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMER
Authorized Official First Name:
PHIL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
479-249-6006

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  AR4369 , 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: 163179128 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com