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General NPI Number Information
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NPI Number | 1649397126
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE EYE CENTER INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 197 HOSPITAL DRIVE SUITE A
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City | CHEROKEE VILLAGE
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State | AR
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Zip | 72529-0000
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Country | US
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Telephone | 870-257-2100
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Fax | 870-257-4395
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Provider Business Mailing Address
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Address Line | 197 HOSPITAL DRIVE SUITE A
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City | CHEROKEE VILLAGE
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State | AR
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Zip | 72529-0000
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Country | US
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Telephone | 870-257-2100
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Fax | 870-257-4395
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY H ELLIS
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Credential | O.D.
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Telephone | 870-257-2100
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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 | 2408
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AR2408
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License Number State | AR
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