Healthcare Provider Details

I. General information

NPI: 1386167419
Provider Name (Legal Business Name): TEXARKANA EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROFESSIONAL PARK DR STE A
ARKADELPHIA AR
71923-5317
US

IV. Provider business mailing address

2703 RICHMOND RD
TEXARKANA TX
75503-2328
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-5090
  • Fax: 870-204-7900
Mailing address:
  • Phone: 903-838-0783
  • Fax: 903-831-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LISA ABNEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 870-774-2020