Organization
SOUTHERN EYE ASSOCIATES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY E CHRONISTER RN (ADMINISTRATOR)
(870) 935-6396
Entity
Organization
Contact information
Practice address
601 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 935-6396
(870) 935-4063
Mailing address
601 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 935-6396
(870) 935-4063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
MC-1284
AR
207W00000X
Ophthalmology Physician
Primary
MC-1284
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116840002
—
AR
01
—
503329807
MISSOURI MEDICAID
MO
01
—
CT1713
RAILROAD MEDICARE
AR
Enumeration date
07/28/2006
Last updated
09/02/2015
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