Provider Demographics
NPI:1063681039
Name:DR. JAMES L. PRICE, JR.
Entity Type:Organization
Organization Name:DR. JAMES L. PRICE, JR.
Other - Org Name:JAMES L PRICE, JR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:870-367-8534
Mailing Address - Street 1:301 HIGHWAY 425 S
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4611
Mailing Address - Country:US
Mailing Address - Phone:870-367-8534
Mailing Address - Fax:870-367-0264
Practice Address - Street 1:301 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4611
Practice Address - Country:US
Practice Address - Phone:870-367-8534
Practice Address - Fax:870-367-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2158152W00000X
AR2158332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102131722Medicaid
AR48603Medicare PIN
AR0261980001Medicare NSC
AR102131722Medicaid