Basic Information
| Provider Information | |||||||||
| NPI: | 1912082751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH ARKANSAS EYE CLINIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 THOMPSON AVE | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717304569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708624216 | ||||||||
| FaxNumber: | 8708629011 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 THOMPSON AVE | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717304569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708624216 | ||||||||
| FaxNumber: | 8708629011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | SIMPSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8708624216 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C4327 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.