Provider Demographics
NPI:1891988200
Name:DECKER EYE CARE, LLC
Entity Type:Organization
Organization Name:DECKER EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-254-9434
Mailing Address - Street 1:813 W CENTRAL AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5787
Mailing Address - Country:US
Mailing Address - Phone:479-855-0009
Mailing Address - Fax:479-876-7105
Practice Address - Street 1:813 W CENTRAL AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5787
Practice Address - Country:US
Practice Address - Phone:479-855-0009
Practice Address - Fax:479-876-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145384722Medicaid
AR145384722Medicaid
AR6015130001Medicare NSC