Provider Demographics
NPI:1184730319
Name:RUSSELLVILLE EYE CLINIC, P.A.
Entity type:Organization
Organization Name:RUSSELLVILLE EYE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-968-7302
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0400
Mailing Address - Country:US
Mailing Address - Phone:479-968-7302
Mailing Address - Fax:479-968-5131
Practice Address - Street 1:2711 E PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2006
Practice Address - Country:US
Practice Address - Phone:479-968-7302
Practice Address - Fax:479-968-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103928002Medicaid
AR103928002Medicaid
AR0464610001Medicare NSC