Healthcare Provider Details

I. General information

NPI: 1710952981
Provider Name (Legal Business Name): RAINES INVISION EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 ALEXANDER DR SUITE E
JONESBORO AR
72401-7070
US

IV. Provider business mailing address

PO BOX 17287
JONESBORO AR
72403-6723
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-3937
  • Fax: 870-336-3934
Mailing address:
  • Phone: 870-336-3937
  • Fax: 870-336-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberPC-130
License Number StateAR

VIII. Authorized Official

Name: DR. STACEY D RAINES
Title or Position: OPTOMETRIC PHYSICIAN
Credential: OD
Phone: 870-336-3937