Provider Demographics
NPI:1386795094
Name:ELITE EYE CARE & OPTICAL LLC
Entity type:Organization
Organization Name:ELITE EYE CARE & OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CADE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-972-6040
Mailing Address - Street 1:2100 E HIGHLAND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5383
Mailing Address - Country:US
Mailing Address - Phone:870-972-6040
Mailing Address - Fax:870-972-5337
Practice Address - Street 1:2100 E HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5383
Practice Address - Country:US
Practice Address - Phone:870-972-6040
Practice Address - Fax:870-972-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5949900001Medicare NSC