Provider Demographics
NPI:1326195181
Name:FAMILY EYE CARE OF RUSSELLVILLE
Entity Type:Organization
Organization Name:FAMILY EYE CARE OF RUSSELLVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-967-0600
Mailing Address - Street 1:2409 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9619
Mailing Address - Country:US
Mailing Address - Phone:479-967-0600
Mailing Address - Fax:
Practice Address - Street 1:2409 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9619
Practice Address - Country:US
Practice Address - Phone:479-967-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C326OtherCLINIC NUMBER