Provider Demographics
NPI:1881852556
Name:JEFF NETZEL O.D. PA
Entity Type:Organization
Organization Name:JEFF NETZEL O.D. PA
Other - Org Name:NETZEL EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMERTRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:NETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-271-2225
Mailing Address - Street 1:1720 S WALTON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7533
Mailing Address - Country:US
Mailing Address - Phone:479-271-2225
Mailing Address - Fax:479-271-6225
Practice Address - Street 1:1720 S WALTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7533
Practice Address - Country:US
Practice Address - Phone:479-271-2225
Practice Address - Fax:479-271-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149489722Medicaid
AR49843Medicare PIN
AR49843Medicare UPIN