Provider Demographics
NPI:1801550264
Name:EYES ON THE SQUARE
Entity type:Organization
Organization Name:EYES ON THE SQUARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-306-8704
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5960
Mailing Address - Country:US
Mailing Address - Phone:479-339-9010
Mailing Address - Fax:479-339-9011
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5960
Practice Address - Country:US
Practice Address - Phone:479-339-9010
Practice Address - Fax:479-339-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty