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General NPI Number Information
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NPI Number | 1679244826
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE CLINIC, PLLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 301 N SHACKLEFORD RD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2843
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Country | US
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Telephone | 501-223-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 241340
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City | LITTLE ROCK
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State | AR
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Zip | 72223-0006
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Country | US
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Telephone | 501-366-7299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PERRY L AMERINE
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Credential | OD
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Telephone | 501-366-7299
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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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