Provider Demographics
NPI:1255633608
Name:AB EYES, PLLC
Entity type:Organization
Organization Name:AB EYES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUREIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-856-3844
Mailing Address - Street 1:100 E JOYCE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6292
Mailing Address - Country:US
Mailing Address - Phone:479-966-4232
Mailing Address - Fax:
Practice Address - Street 1:100 E JOYCE BLVD
Practice Address - Street 2:104
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6292
Practice Address - Country:US
Practice Address - Phone:479-966-4232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171794722Medicaid
AR5G751Medicare PIN