Jacksonville Vision Development Center PA
Organization Active NPI Optometrist · Jacksonville, AR
NPI 1336782846 · NPPES record last updated Dec 17, 2019
Key facts
- NPI
- 1336782846
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- JACKSONVILLE VISION DEVELOPMENT CENTER PA
- Practice address
- 291 N 1St St
Jacksonville, AR 72076-4462 - Phone
- (501) 982-1100
- Fax
- (501) 982-0323
- NPI assigned
- Oct 28, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Patricia Flippin Westfall, OD
- Title
- Owner/President
- Phone
- (501) 268-3577
Practitioners 9
-
Alexandra Reid Meredith, O.D.
-
Allee Yingling, O.D.
-
James Mark Hertzog, O.D.
-
David Justin Manning, O.D.
-
Airiell Schwab, OD
-
Ryan Anderson, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191231000044 | AR | Part B Supplier - Clinic/Group Practice | 3173957024 |
Receives reassigned benefits from 2 practitioners Practice locations: Jacksonville, AR |
National Provider Directory
Locations
401 W Race Ave
AR 72143
291 N 1st St
Jacksonville, AR 72076
Phone (501) 268-3577
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
291 N 1St St
Jacksonville, AR 72076-4462
Mailing address
410 W Race Ave
Searcy, AR 72143-4133
Phone (501) 268-3577
Other providers in Jacksonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.