Provider Demographics
NPI:1316405269
Name:ENVISION EYE CARE
Entity Type:Organization
Organization Name:ENVISION EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-278-0128
Mailing Address - Street 1:7519 PALM BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2009
Mailing Address - Country:US
Mailing Address - Phone:501-278-0128
Mailing Address - Fax:
Practice Address - Street 1:8801 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5901
Practice Address - Country:US
Practice Address - Phone:501-225-5580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty