Provider Demographics
NPI:1356614556
Name:BRIAN W BUELL EYE CARE PA
Entity type:Organization
Organization Name:BRIAN W BUELL EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELL
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:479-521-7774
Mailing Address - Street 1:4083 N SHILOH DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5300
Mailing Address - Country:US
Mailing Address - Phone:479-521-7774
Mailing Address - Fax:479-521-4928
Practice Address - Street 1:4083 N SHILOH DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5300
Practice Address - Country:US
Practice Address - Phone:479-521-7774
Practice Address - Fax:479-521-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPC-055302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106357722Medicaid