Provider Demographics
NPI:1215235882
Name:DR. MARK'S EYE CARE, P.A.
Entity type:Organization
Organization Name:DR. MARK'S EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-452-0928
Mailing Address - Street 1:2228 S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3811
Mailing Address - Country:US
Mailing Address - Phone:479-452-0928
Mailing Address - Fax:479-452-0978
Practice Address - Street 1:2228 S 57TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3811
Practice Address - Country:US
Practice Address - Phone:479-452-0928
Practice Address - Fax:479-452-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49828Medicare PIN
ARU95609Medicare UPIN