Provider Demographics
NPI:1922077304
Name:EYE ASSOCIATES LEASING COMPANY INCORPORATED
Entity Type:Organization
Organization Name:EYE ASSOCIATES LEASING COMPANY INCORPORATED
Other - Org Name:BOOZMAN-HOF OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-246-1700
Mailing Address - Street 1:3737 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1839
Mailing Address - Country:US
Mailing Address - Phone:479-246-1730
Mailing Address - Fax:479-936-8799
Practice Address - Street 1:25 CUNNINGHAM COR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3520
Practice Address - Country:US
Practice Address - Phone:479-246-1730
Practice Address - Fax:479-936-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101176716Medicaid
AR0346340002Medicare NSC