Provider Demographics
NPI:1023592987
Name:C KLEAR VISION INC.
Entity type:Organization
Organization Name:C KLEAR VISION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-764-8245
Mailing Address - Street 1:12400 CANTRELL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1728
Mailing Address - Country:US
Mailing Address - Phone:501-414-8923
Mailing Address - Fax:501-353-2711
Practice Address - Street 1:12400 CANTRELL RD STE 4
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1728
Practice Address - Country:US
Practice Address - Phone:501-764-8216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185154722Medicaid
AR5V265OtherBLUE CROSS BLUE SHIELD