Provider Demographics
NPI:1255652145
Name:KIIHNL EYE CLINIC P A
Entity Type:Organization
Organization Name:KIIHNL EYE CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:KIIHNL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-268-1818
Mailing Address - Street 1:707 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4833
Mailing Address - Country:US
Mailing Address - Phone:501-268-1818
Mailing Address - Fax:501-268-1894
Practice Address - Street 1:707 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4833
Practice Address - Country:US
Practice Address - Phone:501-268-1818
Practice Address - Fax:501-268-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184488722Medicaid
AR184488722Medicaid
6396350001Medicare NSC