Provider Demographics
NPI:1548234669
Name:BOOZMAN-HOF REGIONAL EYE CLINIC PA
Entity Type:Organization
Organization Name:BOOZMAN-HOF REGIONAL EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-246-1700
Mailing Address - Street 1:3737 W. WALNUT
Mailing Address - Street 2:P.O. BOX 1353
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1353
Mailing Address - Country:US
Mailing Address - Phone:479-246-1700
Mailing Address - Fax:479-631-2629
Practice Address - Street 1:3737 W. WALNUT
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72757-1353
Practice Address - Country:US
Practice Address - Phone:479-246-1700
Practice Address - Fax:479-631-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2013-07-23
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
AR112304722Medicaid
AR101143002Medicaid
AR57065Medicare ID - Type Unspecified