Provider Demographics
NPI:1326242710
Name:PRESCRIPTION LENS, INC.
Entity Type:Organization
Organization Name:PRESCRIPTION LENS, INC.
Other - Org Name:LENSMASTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEBO
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:870-972-1818
Mailing Address - Street 1:320 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2912
Mailing Address - Country:US
Mailing Address - Phone:870-972-1818
Mailing Address - Fax:870-972-0356
Practice Address - Street 1:320 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2912
Practice Address - Country:US
Practice Address - Phone:870-972-1818
Practice Address - Fax:870-972-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25089332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48181OtherAR BLUE CROSS BLUE SHIELD
AR0906110001Medicare ID - Type Unspecified