Provider Demographics
NPI:1376973164
Name:SCHLUTERMAN EYE CARE & OPTICAL INC
Entity Type:Organization
Organization Name:SCHLUTERMAN EYE CARE & OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLUTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-646-2555
Mailing Address - Street 1:9220 HIGHWAY 71 S
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9117
Mailing Address - Country:US
Mailing Address - Phone:479-646-2555
Mailing Address - Fax:479-434-4140
Practice Address - Street 1:9220 HIGHWAY 71 S
Practice Address - Street 2:SUITE 10
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9117
Practice Address - Country:US
Practice Address - Phone:479-646-2555
Practice Address - Fax:479-434-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179593722Medicaid
OK200256320Medicaid
OK200256320Medicaid