MEDICARE: EUREKA SPRINGS EYECARE CLINIC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528214863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUREKA SPRINGS EYECARE CLINIC

Provider Business Mailing Address
First Line	:	11225 HURON LN STE 200A
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-1861
Country	:	US
Telephone Number	:	479-253-7136
Fax Number	:	479-253-9479

Provider Business Practice Location Address
First Line	:	3029 E VAN BUREN
Second Line	:
City	:	EUREKA SPRINGS
State	:	AR
Zip	:	72632-9712
Country	:	US
Telephone Number	:	479-253-7136
Fax Number	:	479-253-9479

Authorized Official
Title or Position	:	PARTNER/PROVIDER
Name	:	TASKER RODMAN
Credential	:
Telephone Number	:	479-253-7136

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	07/15/2021

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