Provider Demographics
NPI: | 1962972182 |
---|---|
Name: | ARKANSAS PHYSICIANS EYECARE GROUP CAMPEN, P.A. |
Entity type: | Organization |
Organization Name: | ARKANSAS PHYSICIANS EYECARE GROUP CAMPEN, P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SENIOR REVENUE CYCLE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALISHA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JACKSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 561-208-1591 |
Mailing Address - Street 1: | 1615 S CONGRESS AVE STE 105 |
Mailing Address - Street 2: | |
Mailing Address - City: | DELRAY BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33445-6326 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-275-2020 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 112 S UNIVERSITY AVE |
Practice Address - Street 2: | |
Practice Address - City: | LITTLE ROCK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72205-5203 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-712-5611 |
Practice Address - Fax: | 501-296-9691 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-11-30 |
Last Update Date: | 2024-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |