DR. AMANDA LEANNE MOORE-ELCYZYN (NPI# 1780612499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780612499 |
| Entity Type | Individual |
| Full Name | DR. AMANDA LEANNE MOORE-ELCYZYN |
| Other Name | AMANDA LEANNE MOORE |
| Credential | O.D. |
| Practice Address |
113 W Carpenter St Benton AR 72015-3317 |
| Mailing Address |
1926 W State St Boise ID 83702-3957 |
| Practice Telephone | 5017782363 |
| Practice Fax Number | 5017785329 |
| Mailing Telephone | 2083362020 |
| Mailing Fax Number | 2083845677 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-09-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | ODP-100499 | ID | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 2566 | AR | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | MEDICARE # | 49956 | 01 |
| AR | 161893722 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1926 W State St, Boise, ID 837023957 | 2083362020 |
| Street Address |
113 W CARPENTER ST |
| City | BENTON |
| State | AR |
| Zip Code | 72015-3317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598753279 | Simmons Eye Care Clinic, P.a. | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2005-10-07 |
| 1295387546 | Zachary Thomas Ford | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2019-07-16 |
| 1174009500 | Shelby Rae Brogdon | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2018-07-18 |
| 1447538897 | Jennifer Zierlein | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2011-08-02 |
| 1174837553 | Steele J Zierlein | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2010-07-28 |
| 1073537593 | William D. Simmons | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2006-07-27 |
| 1720016272 | Russell Thomas Simmons | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2006-06-30 |
| 1508894304 | Creighton Alan Simmons | Optometrist | 113 W Carpenter St, Benton, AR 72015-3317 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790343135 | Justin King | Case Manager/Care Coordinator | 1502 Mary Kay Blv6, Benton, AR 72015 | 2019-05-31 |
| 1790253326 | Seth Alexander Weisheit | Nurse Practitioner | 824 Military Road, Benton, AR 72015 | 2018-11-13 |
| 1396269627 | Abby G Sims | Speech-Language Pathologist | 3391 Peachtree Lane, Benton, AR 72015 | 2017-07-28 |
| 1225551278 | Jessica R Poe | Case Manager/Care Coordinator | 1502 Marykay Blvd, Benton, AR 72015 | 2017-07-21 |
| 1003357997 | Jamaal Langston | Case Manager/Care Coordinator | 1502 Mark Kay Blvd, Benton, AR 72015 | 2017-03-13 |
| 1881138550 | Shannon Gachot-ridgley | Counselor | 205 South Street Suite 3, Benton, AR 72015 | 2016-12-14 |
| 1295104578 | Excel Health of Haskell, Pllc | Clinical Nurse Specialist | 6029 Us Hwy 67, Haskell, AR 72015 | 2015-09-17 |
| 1528464054 | Kacey Jo Kiker | Nurse Practitioner | 620 W South St, Benton, AR 72015 | 2014-11-11 |
| 1700218252 | Jamie Brunt | Licensed Practical Nurse | 1718 Old Hot Springs Rd, Benton, AR 72015 | 2013-08-07 |
| 1760738942 | Kari J Richards | Physical Therapist | 5701 Springhill Rd, Bryant, AR 72015 | 2012-07-25 |
| Find all providers in zip 72015 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801340633 | Cvo-bryant, LLC | Optometrist | 20770 I 30, Suite 135, Benton, AR 72019-8022 | 2016-08-10 |
| 1437402609 | Contact Lens Express LLC | Optometrist | 3715 Wildflower Ln, Benton, AR 72015-9000 | 2012-10-24 |
| 1033407226 | David Bryon Glenn | Optometrist | 443 Hwy 5 N, Benton, AR 72019-9778 | 2011-07-21 |
| 1356635510 | Justin B. Franks O.d. P.a. | Optometrist | 3016 Castle Valley Dr, Benton, AR 72019-6976 | 2011-06-06 |
| 1558675157 | Michael Wade Jorgensen | Optometrist | 187 Burt Blvd, Ste A, Benton, LA 71006-4905 | 2010-08-06 |
| 1528371150 | Jamie Byron Johnson | Optometrist | 318 W Sevier St, Benton, AR 72015-4270 | 2010-07-25 |
| 1124257035 | Natasha G. Lyles | Optometrist | 140 Commerce Blvd, Benton, KY 42025-1112 | 2009-07-13 |
| 1669651311 | Benton Eyecare Clinic | Optometrist | 443 Highway 5 N, Benton, AR 72019-9778 | 2007-10-30 |
| 1801839477 | Michael Lynn Hayes | Optometrist | 310 W 5th St, Benton, KY 42025-1102 | 2006-06-13 |
| 1245204304 | Laurel Morris | Optometrist | 109 W 5th St, Benton, KY 42025-1123 | 2006-02-15 |
| Find all providers in BENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.