Provider Demographics
NPI:1346220001
Name:VANSCYOC, CAROL ESTHER (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ESTHER
Last Name:VANSCYOC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 E VAN ASCHE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4916
Mailing Address - Country:US
Mailing Address - Phone:479-442-5227
Mailing Address - Fax:479-582-4952
Practice Address - Street 1:741 E VAN ASCHE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-442-5227
Practice Address - Fax:479-582-4952
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49363OtherBLUE CROSS PROVIDER
AR15666000040OtherQUALCHOICE PROVIDER
AR49363OtherBLUE CROSS PROVIDER
AR49363Medicare ID - Type UnspecifiedMEDICARE PROVIDER