MEDICARE: PRESCRIPTION LENS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	25089	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48181	OTHER	AR	AR BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1326242710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION LENS, INC.

Provider Business Mailing Address
First Line	:	320 S CHURCH ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-2912
Country	:	US
Telephone Number	:	870-972-1818
Fax Number	:	870-972-0356

Provider Business Practice Location Address
First Line	:	320 S CHURCH ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-2912
Country	:	US
Telephone Number	:	870-972-1818
Fax Number	:	870-972-0356

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. RUSTY ACEBO
Credential	:	ABOC
Telephone Number	:	870-972-1818

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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Directions to “PRESCRIPTION LENS, INC. ” Practice Location

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