Provider Demographics
NPI:1588656029
Name:CONTACT LENS & VISION CARE ASSOCIATES PA
Entity Type:Organization
Organization Name:CONTACT LENS & VISION CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:501-945-3460
Mailing Address - Street 1:4450 E MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2519
Mailing Address - Country:US
Mailing Address - Phone:501-945-3460
Mailing Address - Fax:501-945-4076
Practice Address - Street 1:4450 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2519
Practice Address - Country:US
Practice Address - Phone:501-945-3460
Practice Address - Fax:501-945-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2090152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154294722Medicaid
AR154293722Medicaid
ARU00881Medicare UPIN
AR48017Medicare PIN