=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467854620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEEBE FAMILY EYE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2014
-----------------------------------------------------
Last Update Date | 09/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1817 W DEWITT HENRY DR
-----------------------------------------------------
City | BEEBE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72012-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-843-6567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 28
-----------------------------------------------------
City | CABOT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72023-0028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-843-6567
-----------------------------------------------------
Fax | 510-843-2599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEVIN LIVENGOOD
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 713-492-7572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2627
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------