Provider Demographics
NPI:1316963564
Name:VISION CLINIC PC
Entity type:Organization
Organization Name:VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-725-0500
Mailing Address - Street 1:3330 S NATIONAL AVE STE 2020
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7337
Mailing Address - Country:US
Mailing Address - Phone:417-725-0500
Mailing Address - Fax:417-725-0502
Practice Address - Street 1:3440 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7307
Practice Address - Country:US
Practice Address - Phone:417-886-5444
Practice Address - Fax:417-886-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1316963564Medicaid
MO000008989Medicare PIN
MO0464720003Medicare NSC