MEDICARE: EYE GROUP, LLC

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	332H00000X	Eyewear Supplier	2112	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0317710005	OTHER	AR	DMERC MEDICARE

General Provider Information

NPI Number	:	1679793442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE GROUP, LLC

Provider Business Mailing Address
First Line	:	3000 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4232
Country	:	US
Telephone Number	:	479-782-8892
Fax Number	:	479-782-8840

Provider Business Practice Location Address
First Line	:	500 N 6TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-2006
Country	:	US
Telephone Number	:	479-782-8892
Fax Number	:	479-782-8840

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT KNOX
Credential	:
Telephone Number	:	479-782-8892

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	03/14/2018

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