Provider Demographics
NPI:1336782846
Name:JACKSONVILLE VISION DEVELOPMENT CENTER PA
Entity Type:Organization
Organization Name:JACKSONVILLE VISION DEVELOPMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:FLIPPIN
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-268-3577
Mailing Address - Street 1:410 W RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4133
Mailing Address - Country:US
Mailing Address - Phone:501-268-3577
Mailing Address - Fax:501-268-5631
Practice Address - Street 1:291 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4462
Practice Address - Country:US
Practice Address - Phone:501-982-1100
Practice Address - Fax:501-982-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty