Provider Demographics
NPI:1780742973
Name:FAULKNER EYE CLINIC
Entity type:Organization
Organization Name:FAULKNER EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:STUTZMAN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-739-2020
Mailing Address - Street 1:1805 STATE HIGHWAY 77
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9011
Mailing Address - Country:US
Mailing Address - Phone:870-739-2020
Mailing Address - Fax:870-739-2939
Practice Address - Street 1:1805 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9011
Practice Address - Country:US
Practice Address - Phone:870-739-2020
Practice Address - Fax:870-739-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49537Medicare PIN