1427046721 NPI number — LOWERY MEDICAL-SURGICAL EYE CENTER, P.A.

Table of content: (NPI 1427046721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427046721 NPI number — LOWERY MEDICAL-SURGICAL EYE CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWERY MEDICAL-SURGICAL EYE CENTER, P.A.
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:
LOWERY EYE CLINIC
Provider Other Organization Name Type Code:
3
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:
1427046721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CENTRAL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEARCY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72143-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-268-7154
Provider Business Mailing Address Fax Number:
501-268-9071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-268-7154
Provider Business Practice Location Address Fax Number:
501-268-9071
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMUCKER
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-268-7154

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MC1006 , 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: 150603002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com