Provider Demographics
NPI:1003145319
Name:FAMILY EYE CARE CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY EYE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-836-2525
Mailing Address - Street 1:515 CASH RD SW
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3706
Mailing Address - Country:US
Mailing Address - Phone:870-836-2525
Mailing Address - Fax:870-836-7252
Practice Address - Street 1:515 CASH RD SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3706
Practice Address - Country:US
Practice Address - Phone:870-836-2525
Practice Address - Fax:870-836-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2570152W00000X
AR2582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57839OtherARK BCBS-MEDIPAK
AR181078722Medicaid
57839OtherBLUE ADVANTAGE
AR57839OtherARKANSAS BLUE CROSS & BLUE SHIELD
AR57839OtherHEALTH ADVANTAGE
AR57839OtherMEDIPAK ADVANTAGE
AR57839OtherBLUE CARD/ AR BCBS
AR181078722Medicaid
AR6353160001Medicare NSC