Provider Demographics
NPI:1609990357
Name:MCDONALD EYE SERVICES, PA
Entity Type:Organization
Organization Name:MCDONALD EYE SERVICES, PA
Other - Org Name:MCDONALD EYE OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SYLER
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:479-521-2555
Mailing Address - Street 1:3318 N NORTHHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4008
Mailing Address - Country:US
Mailing Address - Phone:479-521-2555
Mailing Address - Fax:479-521-6761
Practice Address - Street 1:3318 N NORTHHILLS BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4008
Practice Address - Country:US
Practice Address - Phone:479-521-2555
Practice Address - Fax:479-521-6761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDONALD EYE SERVICES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1021780001Medicare ID - Type UnspecifiedDEMRC NUMBER