Provider Demographics
NPI:1184889040
Name:BEAVERS EYE CARE, INC.
Entity type:Organization
Organization Name:BEAVERS EYE CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-631-2030
Mailing Address - Street 1:3167 N KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6523
Mailing Address - Country:US
Mailing Address - Phone:479-631-2030
Mailing Address - Fax:479-631-1530
Practice Address - Street 1:4208 PLEASANT CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1345
Practice Address - Country:US
Practice Address - Phone:479-631-2030
Practice Address - Fax:479-631-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty