Provider Demographics
NPI:1427142934
Name:JEFFRIES EYE CLINIC PA
Entity type:Organization
Organization Name:JEFFRIES EYE CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-631-8900
Mailing Address - Street 1:3602 W SOUTHERN HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8013
Mailing Address - Country:US
Mailing Address - Phone:479-631-8900
Mailing Address - Fax:479-899-6698
Practice Address - Street 1:3602 W SOUTHERN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8013
Practice Address - Country:US
Practice Address - Phone:479-631-8900
Practice Address - Fax:479-899-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148694002Medicaid
AR5C726Medicare PIN
G29100Medicare UPIN