Healthcare Provider Details

I. General information

NPI: 1114052164
Provider Name (Legal Business Name): MERTINS FAMILY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 N GARLAND AVE STE 110
FAYETTEVILLE AR
72701-3072
US

IV. Provider business mailing address

640 N GARLAND AVE STE 110
FAYETTEVILLE AR
72701-3072
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-8400
  • Fax: 800-807-8144
Mailing address:
  • Phone: 479-442-8400
  • Fax: 888-975-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2462
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2462
License Number StateAR

VIII. Authorized Official

Name: DR. ALLYSON MERTINS
Title or Position: OWNER
Credential: O.D.
Phone: 479-442-8400