Provider Demographics
NPI:1013189950
Name:BILLINGSLEY EYE CLINIC
Entity Type:Organization
Organization Name:BILLINGSLEY EYE CLINIC
Other - Org Name:BILLINGSLEY EYE PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER MD OPTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:479-524-6115
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-0339
Mailing Address - Country:US
Mailing Address - Phone:479-524-6115
Mailing Address - Fax:479-524-6116
Practice Address - Street 1:1675 W JEFFERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3057
Practice Address - Country:US
Practice Address - Phone:479-524-6115
Practice Address - Fax:479-524-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0342207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149278002Medicaid
OK20011970AMedicaid
G02593Medicare UPIN
5J702Medicare PIN