Healthcare Provider Details

I. General information

NPI: 1629169727
Provider Name (Legal Business Name): EYE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 E MILLSAP RD
FAYETTEVILLE AR
72703-4096
US

IV. Provider business mailing address

594 E MILLSAP RD
FAYETTEVILLE AR
72703-4096
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-2020
  • Fax: 479-521-3988
Mailing address:
  • Phone: 479-442-2020
  • Fax: 479-521-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAILA R JAMES
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 479-442-2020