Provider Demographics
NPI:1205171873
Name:EYE GROUP LLC
Entity type:Organization
Organization Name:EYE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-782-8892
Mailing Address - Street 1:3000 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4232
Mailing Address - Country:US
Mailing Address - Phone:479-782-8892
Mailing Address - Fax:479-782-8840
Practice Address - Street 1:1435 WEST CENTER STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3414
Practice Address - Country:US
Practice Address - Phone:479-996-2020
Practice Address - Fax:479-996-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128041002Medicaid
AR5B728Medicare UPIN
AR128041002Medicaid