Provider Demographics
NPI:1194947564
Name:EYE CARE OPTICAL
Entity type:Organization
Organization Name:EYE CARE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-0606
Mailing Address - Street 1:715 NORTH MORLEY STREET
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2617
Mailing Address - Country:US
Mailing Address - Phone:660-263-0606
Mailing Address - Fax:660-263-0808
Practice Address - Street 1:715 NORTH MORLEY STREET
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2617
Practice Address - Country:US
Practice Address - Phone:660-263-0606
Practice Address - Fax:660-263-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty