Provider Demographics
NPI:1821262155
Name:CUSTOMEYES VISION CARE OF POCAHONTAS
Entity Type:Organization
Organization Name:CUSTOMEYES VISION CARE OF POCAHONTAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-9169
Mailing Address - Street 1:204 N THOMASVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2665
Mailing Address - Country:US
Mailing Address - Phone:870-892-9169
Mailing Address - Fax:870-892-4031
Practice Address - Street 1:204 N THOMASVILLE AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-2665
Practice Address - Country:US
Practice Address - Phone:870-892-9169
Practice Address - Fax:870-892-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6227150001Medicare NSC
5G139Medicare PIN