Provider Demographics
NPI:1992232102
Name:SS EYE GROUP, PLLC
Entity type:Organization
Organization Name:SS EYE GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-778-2363
Mailing Address - Street 1:113 W CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3317
Mailing Address - Country:US
Mailing Address - Phone:501-778-2363
Mailing Address - Fax:501-778-5329
Practice Address - Street 1:11115 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3807
Practice Address - Country:US
Practice Address - Phone:501-224-7056
Practice Address - Fax:501-224-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty