Healthcare Provider Details

I. General information

NPI: 1073581575
Provider Name (Legal Business Name): FAMILY EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

IV. Provider business mailing address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-7800
  • Fax: 501-835-5060
Mailing address:
  • Phone: 501-835-7800
  • Fax: 501-835-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2348
License Number StateAR

VIII. Authorized Official

Name: KRISTIN LAW
Title or Position: TREASURER/OPTOMETRIST
Credential:
Phone: 479-965-6300