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General NPI Number Information
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NPI Number | 1255633608
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Entity Type | Organization
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Legal Business Name | AB EYES, PLLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 100 E JOYCE BLVD 104
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6292
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Country | US
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Telephone | 479-966-4232
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E JOYCE BLVD STE 100
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6292
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Country | US
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Telephone | 479-966-4232
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MEGAN BAUREIS
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Credential | O.D.
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Telephone | 479-856-3844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2599
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License Number State | AR
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