Healthcare Provider Details

I. General information

NPI: 1083984116
Provider Name (Legal Business Name): BENTONVILLE EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date: 09/30/2025
Reactivation Date: 12/15/2025

III. Provider practice location address

2300 SE J ST STE 12
BENTONVILLE AR
72712-3776
US

IV. Provider business mailing address

2300 SE J ST STE 12
BENTONVILLE AR
72712-3776
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-3268
  • Fax: 479-268-4019
Mailing address:
  • Phone: 479-268-3268
  • Fax: 479-268-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH JANE NELSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 623-640-6059