Provider Demographics
NPI:1427413558
Name:TEXARKANA EYE ASSOCIATES
Entity Type:Organization
Organization Name:TEXARKANA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-838-0731
Mailing Address - Street 1:2510 N HERVEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8419
Mailing Address - Country:US
Mailing Address - Phone:870-722-2200
Mailing Address - Fax:
Practice Address - Street 1:2703 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2328
Practice Address - Country:US
Practice Address - Phone:903-838-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty