Provider Demographics
NPI:1083984116
Name:BENTONVILLE EYE CARE PLLC
Entity type:Organization
Organization Name:BENTONVILLE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-268-3268
Mailing Address - Street 1:2300 SE J ST STE 12
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3776
Mailing Address - Country:US
Mailing Address - Phone:479-268-3268
Mailing Address - Fax:479-268-4019
Practice Address - Street 1:2300 SE J ST STE 12
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3776
Practice Address - Country:US
Practice Address - Phone:479-268-3268
Practice Address - Fax:479-268-4019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENTONVILLE EYE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty