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General NPI Number Information
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NPI Number | 1548416142
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Entity Type | Organization
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Legal Business Name | BANKS FAMILY EYE CLINIC PLLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 2901 E ZION RD STE 4
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5070
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Country | US
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Telephone | 479-443-2025
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Fax | 479-443-2032
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Provider Business Mailing Address
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Address Line | 2901 E ZION RD STE 4
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5070
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Country | US
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Telephone | 479-443-2025
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Fax | 479-443-2032
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIA C BANKS
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Credential |
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Telephone | 479-443-2025
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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 | AR2007
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License Number State | AR
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