Healthcare Provider Details

I. General information

NPI: 1265767990
Provider Name (Legal Business Name): MAGIE EYE CLINIC OF MORRILTON,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E HARDING ST
MORRILTON AR
72110-2250
US

IV. Provider business mailing address

810 E HARDING ST
MORRILTON AR
72110-2250
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-3937
  • Fax: 501-354-9111
Mailing address:
  • Phone: 501-354-3937
  • Fax: 501-354-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC2717
License Number StateAR

VIII. Authorized Official

Name: DR. JIMMIE JOHN MAGIE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 501-652-0656