Provider Demographics
NPI:1689822637
Name:LEE ANDREW ST.PIERRE
Entity Type:Organization
Organization Name:LEE ANDREW ST.PIERRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-483-3937
Mailing Address - Street 1:2917 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-3114
Practice Address - Country:US
Practice Address - Phone:870-483-3937
Practice Address - Fax:870-483-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR49327332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134079722Medicaid
ARU67887Medicare UPIN
AR134079722Medicaid
AR49327Medicare PIN