Healthcare Provider Details

I. General information

NPI: 1588648992
Provider Name (Legal Business Name): MAGIE MABREY EYE CLINIC, P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MAIN ST
CONWAY AR
72032
US

IV. Provider business mailing address

924 MAIN ST
CONWAY AR
72032-5424
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-4444
  • Fax: 501-327-3962
Mailing address:
  • Phone: 501-327-4444
  • Fax: 501-327-3962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL LYNN PETERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-327-4444