Healthcare Provider Details

I. General information

NPI: 1316435654
Provider Name (Legal Business Name): TEXARKANA EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N MAIN ST STE 3
NASHVILLE AR
71852-2000
US

IV. Provider business mailing address

2703 RICHMOND RD
TEXARKANA TX
75503-2328
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-3725
  • Fax:
Mailing address:
  • Phone: 903-838-0783
  • Fax: 903-831-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN M BAKER
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 903-838-0783