Provider Demographics
NPI:1912169772
Name:HEBER SPRINGS EYE CARE CENTER PC
Entity Type:Organization
Organization Name:HEBER SPRINGS EYE CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-362-8191
Mailing Address - Street 1:509 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2513
Mailing Address - Country:US
Mailing Address - Phone:501-362-8191
Mailing Address - Fax:
Practice Address - Street 1:509 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2513
Practice Address - Country:US
Practice Address - Phone:501-362-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1912169772OtherRAILROAD MEDICARE
AR6123570001OtherMEDICARE DMERC REGION C
AR171794722Medicaid
AR6123570001Medicare NSC
AR56059Medicare PIN