Provider Demographics
NPI:1508006438
Name:SPECIALTY EYECARE OF SOUTH ARKANSAS LLC
Entity Type:Organization
Organization Name:SPECIALTY EYECARE OF SOUTH ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CAVIN
Authorized Official - Last Name:CLAYCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-367-8534
Mailing Address - Street 1:301 HIGHWAY 425 S
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4611
Mailing Address - Country:US
Mailing Address - Phone:870-367-8534
Mailing Address - Fax:870-367-0264
Practice Address - Street 1:301 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4611
Practice Address - Country:US
Practice Address - Phone:870-367-8534
Practice Address - Fax:870-367-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2158152W00000X
ARC7907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty