Provider Demographics
NPI:1124206743
Name:VELVET'S OPTIQUE
Entity Type:Organization
Organization Name:VELVET'S OPTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELVET
Authorized Official - Middle Name:L
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:870-698-2020
Mailing Address - Street 1:2511 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7424
Mailing Address - Country:US
Mailing Address - Phone:870-698-2020
Mailing Address - Fax:870-698-9371
Practice Address - Street 1:2511 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7424
Practice Address - Country:US
Practice Address - Phone:870-698-2020
Practice Address - Fax:870-698-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL930710156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4896680001Medicare NSC