Provider Demographics
NPI:1184967291
Name:AMEDCO ARKANSAS PLLC
Entity type:Organization
Organization Name:AMEDCO ARKANSAS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER (PRESIDENT)
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-967-4711
Mailing Address - Street 1:302 NORTH PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801
Mailing Address - Country:US
Mailing Address - Phone:479-967-4711
Mailing Address - Fax:479-967-4485
Practice Address - Street 1:302 N. PHOENIX AVE.
Practice Address - Street 2:CLARK EYE CLINIC
Practice Address - City:RUSSELLVILLE,
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-967-4711
Practice Address - Fax:479-967-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty