MEDICARE: EYE CARE OF TRUMANN, 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	2384	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932179942	OTHER	AR	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1245522291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE OF TRUMANN, INC

Provider Business Mailing Address
First Line	:	1009 HIGHWAY 18
Second Line	:	AR CARE
City	:	LAKE CITY
State	:	AR
Zip	:	72437-9622
Country	:	US
Telephone Number	:	870-598-4002
Fax Number	:	870-215-0288

Provider Business Practice Location Address
First Line	:	1009 HIGHWAY 18
Second Line	:	AR CARE
City	:	LAKE CITY
State	:	AR
Zip	:	72437-9622
Country	:	US
Telephone Number	:	870-598-4002
Fax Number	:	870-215-0288

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ANGELA CAROL HOWELL
Credential	:	OD
Telephone Number	:	870-598-4002

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	04/21/2016

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