1245522291 NPI number — EYE CARE OF TRUMANN, INC

Table of content: (NPI 1245522291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245522291 NPI number — EYE CARE OF TRUMANN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE OF TRUMANN, 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:
6
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:
1245522291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 HIGHWAY 18
Provider Second Line Business Mailing Address:
AR CARE
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72437-9622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-598-4002
Provider Business Mailing Address Fax Number:
870-215-0288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 HIGHWAY 18
Provider Second Line Business Practice Location Address:
AR CARE
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72437-9622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-598-4002
Provider Business Practice Location Address Fax Number:
870-215-0288
Provider Enumeration Date:
05/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOWELL
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
870-598-4002

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2384 , 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: 1932179942 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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