Provider Demographics
NPI:1598989501
Name:JOE B COLLINS, OD, PA
Entity Type:Organization
Organization Name:JOE B COLLINS, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:501-982-1100
Mailing Address - Street 1:291 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4462
Mailing Address - Country:US
Mailing Address - Phone:501-982-1100
Mailing Address - Fax:501-982-0323
Practice Address - Street 1:291 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4462
Practice Address - Country:US
Practice Address - Phone:501-982-1100
Practice Address - Fax:501-982-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2045152W00000X
AROP1100081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherDR JOE COLLINS
ART20132Medicare UPIN
AR47750Medicare ID - Type UnspecifiedDR. JOE COLLINS
ART20155Medicare UPIN
AR48029Medicare ID - Type UnspecifiedDR. JERRY PARK