Eye Center, PA
Organization Active NPI Ophthalmology Physician · Fayetteville, AR
NPI 1629169727 · NPPES record last updated Jul 16, 2013
Key facts
- NPI
- 1629169727
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- EYE CENTER, PA
- Practice address
- 594 E Millsap Rd
Fayetteville, AR 72703-4096 - Phone
- (479) 442-2020
- Fax
- (479) 521-3988
- NPI assigned
- Sep 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Shaila R James, MBA
- Title
- Administrator
- Phone
- (479) 442-2020
Practitioners 13
-
Craig J Brown, M.D.
-
Marcus Cooke, O.D.
-
Andy Langston, OD, PA
-
Jonathan F Shaver, O.D.
-
Tamara Ann Morris, O.D.
-
Kellye A Smith, M.D.
-
Kellie Crowl, NP-C
-
Susan A Vaughan, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2031887 | The Eye Center, PA | Certificate of waiver | Oct 30, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| The Eye Center |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040917000683 | AR | Part B Supplier - Clinic/Group Practice | 5395713382 |
Receives reassigned benefits from 10 practitioners Practice locations: Fayetteville, AR |
| O20100930010778 | AR | DME Supplier - Physician - Ophthalmology |
5395713382 | Practice locations: Fayetteville, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
594 E Millsap Rd
Fayetteville, AR 72703-4096
Mailing address
594 E Millsap Rd
Fayetteville, AR 72703-4096
Phone (479) 442-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113066002 | Medicaid | AR | |
| 127791722 | Medicaid | AR |
Other names
- Eye Center, PA
Other providers in Fayetteville, AR
- Everydaymatters, LLC
- Evey Fortin LMT LLC
- Timothy Kenneth Evitt
- Jonathan Scott Ewin
- Donald C Ewing
- Eyemart Express LLC
- Eyemart Express, LTD
- Richard Ivy Ezell
- Sally Lynn Ezell
- Jennifer Faddis
All providers in Fayetteville, AR · Ophthalmology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2013. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.