1649221730 NPI number — SALINE OPTICAL, INC.

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 1649221730 NPI number — SALINE OPTICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALINE OPTICAL, INC.
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:
1649221730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE300
Provider Business Mailing Address City Name:
BENTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72015-3728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-778-1113
Provider Business Mailing Address Fax Number:
501-778-5391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE300
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72015-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-778-1113
Provider Business Practice Location Address Fax Number:
501-778-5391
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
501-778-1113

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4167140001 . This is a "DMERC MEDICARE/CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5B790 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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