Provider Demographics
NPI:1407850217
Name:MCDONALD EYE SERVICES, PA
Entity Type:Organization
Organization Name:MCDONALD EYE SERVICES, PA
Other - Org Name:MCDONALD EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-2555
Mailing Address - Street 1:3689 N STEELE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5347
Mailing Address - Country:US
Mailing Address - Phone:479-521-2555
Mailing Address - Fax:479-521-6761
Practice Address - Street 1:3689 N STEELE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5347
Practice Address - Country:US
Practice Address - Phone:479-521-2555
Practice Address - Fax:479-521-6761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDONALD EYE SERVICES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127513002Medicaid
AR127505722Medicaid
AR127505722Medicaid