MEDICARE: EYE CARE SPECIALTIES, 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	152W00000X	Optometrist	AR 2436	AR
2	152W00000X	Optometrist	AR 2435	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B824	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1407818776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE SPECIALTIES, INC.

Provider Business Mailing Address
First Line	:	101 PLAZA CARMONA PL
Second Line	:	SUITE C
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-3000
Country	:	US
Telephone Number	:	501-922-5778
Fax Number	:	501-922-6659

Provider Business Practice Location Address
First Line	:	101 PLAZA CARMONA PL
Second Line	:	SUITE C
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-3000
Country	:	US
Telephone Number	:	501-922-5778
Fax Number	:	501-922-6659

Authorized Official
Title or Position	:	OPTOMETRIST/ VICE-PRESIDENT
Name	:	DR. SUSAN SEMMLER
Credential	:	O.D.
Telephone Number	:	501-922-5778

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	01/11/2008

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Directions to “EYE CARE SPECIALTIES, INC. ” Practice Location

Language	Start Address	Practice Location

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