Provider Demographics
NPI:1629169727
Name:EYE CENTER, PA
Entity Type:Organization
Organization Name:EYE CENTER, PA
Other - Org Name:EYE CENTER, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:479-442-2020
Mailing Address - Street 1:594 E MILLSAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4096
Mailing Address - Country:US
Mailing Address - Phone:479-442-2020
Mailing Address - Fax:479-521-3988
Practice Address - Street 1:594 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4096
Practice Address - Country:US
Practice Address - Phone:479-442-2020
Practice Address - Fax:479-521-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113066002Medicaid
AR127791722Medicaid
AR0178640001Medicare NSC
AR113066002Medicaid