Provider Demographics
NPI:1891968467
Name:ARKADELPHIA EYE CLINIC INC.
Entity Type:Organization
Organization Name:ARKADELPHIA EYE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFTON
Authorized Official - Middle Name:CONNOR
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-246-5090
Mailing Address - Street 1:911 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5931
Mailing Address - Country:US
Mailing Address - Phone:870-246-5090
Mailing Address - Fax:870-246-7421
Practice Address - Street 1:911 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5931
Practice Address - Country:US
Practice Address - Phone:870-246-5090
Practice Address - Fax:870-246-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0170040001Medicare NSC