Provider Demographics
NPI:1245522291
Name:EYE CARE OF TRUMANN, INC
Entity type:Organization
Organization Name:EYE CARE OF TRUMANN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-598-4002
Mailing Address - Street 1:1009 HIGHWAY 18
Mailing Address - Street 2:AR CARE
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437-9622
Mailing Address - Country:US
Mailing Address - Phone:870-598-4002
Mailing Address - Fax:870-215-0288
Practice Address - Street 1:1009 HIGHWAY 18
Practice Address - Street 2:AR CARE
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9622
Practice Address - Country:US
Practice Address - Phone:870-598-4002
Practice Address - Fax:870-215-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1932179942OtherINDIVIDUAL NPI