1144634064 NPI number — MCALISTER VISION CLINIC

Table of content: (NPI 1144634064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144634064 NPI number — MCALISTER VISION CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCALISTER VISION CLINIC
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:
1144634064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 857
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72740-0857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-738-2040
Provider Business Mailing Address Fax Number:
479-738-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 N GASKILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72740-8966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-738-2040
Provider Business Practice Location Address Fax Number:
479-738-6410
Provider Enumeration Date:
06/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCALISTER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
479-738-2040

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2298 , 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: 103297722 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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