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General NPI Number Information
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NPI Number | 1710952981
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Entity Type | Organization
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Legal Business Name | RAINES INVISION EYECARE
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 2704 ALEXANDER DR SUITE E
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City | JONESBORO
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State | AR
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Zip | 72401-7070
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Country | US
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Telephone | 870-336-3937
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Fax | 870-336-3934
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Provider Business Mailing Address
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Address Line | PO BOX 17287
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City | JONESBORO
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State | AR
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Zip | 72403-6723
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Country | US
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Telephone | 870-336-3937
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Fax | 870-336-3934
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Authorized Official
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Title or Position | OPTOMETRIC PHYSICIAN
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Name | DR. STACEY D RAINES
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Credential | OD
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Telephone | 870-336-3937
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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 | PC-130
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License Number State | AR
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