Provider Demographics
NPI:1114052164
Name:MERTINS FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:MERTINS FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-442-8400
Mailing Address - Street 1:640 N GARLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3072
Mailing Address - Country:US
Mailing Address - Phone:479-442-8400
Mailing Address - Fax:888-975-0944
Practice Address - Street 1:640 N GARLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3072
Practice Address - Country:US
Practice Address - Phone:479-442-8400
Practice Address - Fax:800-807-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2462152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49239OtherBCBS
AR132197722Medicaid
AR5776340001Medicare NSC
ARU66956Medicare UPIN