Individual
DR. NICK D BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2901 E ZION RD, STE 4, FAYETTEVILLE, AR 72703-5007
(479) 443-2025
(479) 443-2032
Mailing address
2901 E ZION RD, STE 4, FAYETTEVILLE, AR 72703-5007
(479) 443-2025
(479) 443-2032
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2007
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106310722
—
AR
01
—
263122083
TAX ID
AR
01
—
410038411
RAILROAD MEDICARE
—
01
—
47968
ARKANSAS BCBS
AR
01
—
710814666
TID
—
01
—
BA700418
HIGHMARK BCBS
—
Enumeration date
12/05/2005
Last updated
12/08/2008
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