Provider Demographics
NPI:1154394617
Name:EYE GROUP, LLC
Entity type:Organization
Organization Name:EYE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-782-8892
Mailing Address - Street 1:3000 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4232
Mailing Address - Country:US
Mailing Address - Phone:479-782-8892
Mailing Address - Fax:479-782-8840
Practice Address - Street 1:7901 DALLAS ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4281
Practice Address - Country:US
Practice Address - Phone:479-782-8892
Practice Address - Fax:479-782-8840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-07
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128046722Medicaid
AR5B728OtherBCBS