Provider Demographics
NPI:1548416142
Name:BANKS FAMILY EYE CLINIC PLLC
Entity Type:Organization
Organization Name:BANKS FAMILY EYE CLINIC PLLC
Other - Org Name:NICK D BANKS OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-443-2025
Mailing Address - Street 1:2901 E ZION RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5070
Mailing Address - Country:US
Mailing Address - Phone:479-443-2025
Mailing Address - Fax:479-443-2032
Practice Address - Street 1:2901 E ZION RD STE 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5070
Practice Address - Country:US
Practice Address - Phone:479-443-2025
Practice Address - Fax:479-443-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6349780001Medicare NSC
AR5G091Medicare PIN