Provider Demographics
NPI:1528214863
Name:EUREKA SPRINGS EYECARE CLINIC
Entity Type:Organization
Organization Name:EUREKA SPRINGS EYECARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TASKER
Authorized Official - Middle Name:
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-253-7136
Mailing Address - Street 1:11225 HURON LN STE 200A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1861
Mailing Address - Country:US
Mailing Address - Phone:479-253-7136
Mailing Address - Fax:479-253-9479
Practice Address - Street 1:3029 E VAN BUREN
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9712
Practice Address - Country:US
Practice Address - Phone:479-253-7136
Practice Address - Fax:479-253-9479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177918722Medicaid
ARDP3884OtherRAILROAD MEDICARE
ARDP3884Medicare UPIN
AR177918722Medicaid
AR5G261Medicare PIN