Provider Demographics
NPI:1710952981
Name:RAINES INVISION EYECARE
Entity Type:Organization
Organization Name:RAINES INVISION EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-336-3937
Mailing Address - Street 1:PO BOX 17287
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6723
Mailing Address - Country:US
Mailing Address - Phone:870-336-3937
Mailing Address - Fax:870-336-3934
Practice Address - Street 1:2704 ALEXANDER DR
Practice Address - Street 2:SUITE E
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7070
Practice Address - Country:US
Practice Address - Phone:870-336-3937
Practice Address - Fax:870-336-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPC-130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR25158OtherSPECTERA
AR5069225OtherAETNA
AR155047722Medicaid
AR00696627OtherOPTICHOICE
AR5F149OtherBLUE CROSS BLUE SHIELD
AR5F149OtherBLUE CROSS BLUE SHIELD
AR25158OtherSPECTERA