Provider Demographics
NPI:1265767990
Name:MAGIE EYE CLINIC OF MORRILTON,PA
Entity type:Organization
Organization Name:MAGIE EYE CLINIC OF MORRILTON,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-652-0656
Mailing Address - Street 1:810 E HARDING ST
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-2250
Mailing Address - Country:US
Mailing Address - Phone:501-354-3937
Mailing Address - Fax:501-354-9111
Practice Address - Street 1:810 E HARDING ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-2250
Practice Address - Country:US
Practice Address - Phone:501-354-3937
Practice Address - Fax:501-354-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC2717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6446310001Medicare NSC