Healthcare Provider Details

I. General information

NPI: 1023366234
Provider Name (Legal Business Name): MAGIE EYE CLINIC OF MORRILTON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/17/2012
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 Code332S00000X
TaxonomyHearing Aid Equipment
License NumberMC-2736
License Number StateAR

VIII. Authorized Official

Name: DR. JIMMIE J MAGIE
Title or Position: OWNER
Credential: M.D.
Phone: 501-354-3937