MEDICARE: C KLEAR VISION INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5V265	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1023592987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C KLEAR VISION INC.

Provider Business Mailing Address
First Line	:	12400 CANTRELL RD STE 4
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1728
Country	:	US
Telephone Number	:	501-414-8923
Fax Number	:	501-353-2711

Provider Business Practice Location Address
First Line	:	12400 CANTRELL RD STE 4
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1728
Country	:	US
Telephone Number	:	501-764-8216
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CELINA CECILE WATSON
Credential	:	O.D.
Telephone Number	:	501-764-8245

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	03/08/2019

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