Provider Demographics
NPI:1770601742
Name:LEE ANDREW ST PIERRE
Entity type:Organization
Organization Name:LEE ANDREW ST PIERRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-802-2020
Mailing Address - Street 1:2917 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7203
Mailing Address - Country:US
Mailing Address - Phone:870-802-2020
Mailing Address - Fax:870-931-7976
Practice Address - Street 1:2917 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7203
Practice Address - Country:US
Practice Address - Phone:870-802-2020
Practice Address - Fax:870-931-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134079722Medicaid
AR1265260001Medicare NSC
AR134079722Medicaid
AR49327Medicare PIN