Provider Demographics
NPI:1669744371
Name:THE EYE DOCTOR LLC
Entity type:Organization
Organization Name:THE EYE DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYMBERLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-766-4488
Mailing Address - Street 1:9300 BROCKINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120
Mailing Address - Country:US
Mailing Address - Phone:501-753-3000
Mailing Address - Fax:501-833-8311
Practice Address - Street 1:9300 BROCKINGTON RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120
Practice Address - Country:US
Practice Address - Phone:501-753-3000
Practice Address - Fax:501-833-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty