Provider Demographics
NPI:1780658245
Name:ROGERS AR OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:ROGERS AR OPHTHALMOLOGY ASC LLC
Other - Org Name:BOOZMAN-HOF EYE SURGERY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1353
Mailing Address - Country:US
Mailing Address - Phone:479-246-1751
Mailing Address - Fax:479-631-2702
Practice Address - Street 1:3737 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-1839
Practice Address - Country:US
Practice Address - Phone:479-246-1751
Practice Address - Fax:479-631-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4136261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149787128Medicaid
AR=========727560000OtherTRICARE
AR04C0001029Medicare Oscar/Certification
AR=========727560000OtherTRICARE
AR11029Medicare PIN