Provider Demographics
NPI:1467590950
Name:AMY J S DAIBER OD PA
Entity Type:Organization
Organization Name:AMY J S DAIBER OD PA
Other - Org Name:DAIBER VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:DAIBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-967-6113
Mailing Address - Street 1:204 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3824
Mailing Address - Country:US
Mailing Address - Phone:479-229-1467
Mailing Address - Fax:479-229-1260
Practice Address - Street 1:204 N FRONT ST
Practice Address - Street 2:DAIBER VISION CARE
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3824
Practice Address - Country:US
Practice Address - Phone:479-967-6113
Practice Address - Fax:479-968-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1224667722Medicaid
48605OtherBLUE CROSS BLUE SHIELD GR
48605OtherBLUE CROSS BLUE SHIELD GR