Provider Demographics
NPI:1679244826
Name:ADVANCED EYECARE CLINIC, PLLC
Entity Type:Organization
Organization Name:ADVANCED EYECARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMERINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-366-7299
Mailing Address - Street 1:PO BOX 241340
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0006
Mailing Address - Country:US
Mailing Address - Phone:501-366-7299
Mailing Address - Fax:
Practice Address - Street 1:301 N SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2843
Practice Address - Country:US
Practice Address - Phone:501-223-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty