Provider Demographics
NPI:1558504233
Name:WELLS EYE CARE, LLC.
Entity Type:Organization
Organization Name:WELLS EYE CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-740-2263
Mailing Address - Street 1:628 LEAH LN
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-9128
Mailing Address - Country:US
Mailing Address - Phone:870-740-2263
Mailing Address - Fax:
Practice Address - Street 1:1500 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2522
Practice Address - Country:US
Practice Address - Phone:573-888-5331
Practice Address - Fax:573-888-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2008017057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty