Provider Demographics
NPI:1538345970
Name:HARRELL EYE CLINIC PA
Entity type:Organization
Organization Name:HARRELL EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-3341
Mailing Address - Street 1:PO BOX 16607
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6710
Mailing Address - Country:US
Mailing Address - Phone:870-932-3341
Mailing Address - Fax:870-932-4636
Practice Address - Street 1:1716 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6092
Practice Address - Country:US
Practice Address - Phone:870-932-3341
Practice Address - Fax:870-932-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47954OtherBLUE CROSS BLUE SHIELD
ART20148Medicare UPIN
AR47954Medicare PIN
AR5985020001Medicare NSC