Provider Demographics
NPI:1386737021
Name:ARKANSAS OUTPATIENT EYE SURGERY LLC
Entity type:Organization
Organization Name:ARKANSAS OUTPATIENT EYE SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-249-6006
Mailing Address - Street 1:3689 N STEELE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5347
Mailing Address - Country:US
Mailing Address - Phone:479-249-6006
Mailing Address - Fax:479-287-4294
Practice Address - Street 1:3689 N STEELE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5347
Practice Address - Country:US
Practice Address - Phone:479-249-6006
Practice Address - Fax:479-287-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4369261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163179128Medicaid
AR11068Medicare PIN