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General NPI Number Information
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NPI Number | 1427194919
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Entity Type | Organization
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Legal Business Name | BERRYVILLE EYECARE CLINIC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 404 W COLLEGE AVE
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City | BERRYVILLE
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State | AR
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Zip | 72616-3142
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Country | US
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Telephone | 870-423-2576
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Fax | 870-423-6750
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Provider Business Mailing Address
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Address Line | 11225 HURON LN STE 200A
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City | LITTLE ROCK
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State | AR
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Zip | 72211-1861
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Country | US
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Telephone | 870-423-2576
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Fax | 870-423-6750
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Authorized Official
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Title or Position | ACCTS RECD
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Name | MARANDA DEAN
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Credential |
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Telephone | 870-350-0777
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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 |
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License Number State |
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