Provider Demographics
NPI:1912570920
Name:FAYETTEVILLE FAMILY EYE CARE
Entity Type:Organization
Organization Name:FAYETTEVILLE FAMILY EYE CARE
Other - Org Name:FAYETTEVILLE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-339-1116
Mailing Address - Street 1:980 SILVER MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-7047
Mailing Address - Country:US
Mailing Address - Phone:903-306-8704
Mailing Address - Fax:
Practice Address - Street 1:3919 N MALL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4906
Practice Address - Country:US
Practice Address - Phone:479-339-1116
Practice Address - Fax:479-339-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty