Provider Demographics
NPI:1962836585
Name:FAMILY EYECARE CENTER INC
Entity type:Organization
Organization Name:FAMILY EYECARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:870-352-2167
Mailing Address - Street 1:312 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3318
Mailing Address - Country:US
Mailing Address - Phone:870-352-2167
Mailing Address - Fax:870-352-8883
Practice Address - Street 1:312 N SPRING ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3318
Practice Address - Country:US
Practice Address - Phone:870-352-2167
Practice Address - Fax:870-352-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty