Provider Demographics
NPI:1366423766
Name:CARTHAGE EYE CARE PC
Entity type:Organization
Organization Name:CARTHAGE EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:LEONA
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-358-2950
Mailing Address - Street 1:130 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-1627
Mailing Address - Country:US
Mailing Address - Phone:417-358-2950
Mailing Address - Fax:417-358-4204
Practice Address - Street 1:130 E 4TH ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1627
Practice Address - Country:US
Practice Address - Phone:417-358-2950
Practice Address - Fax:417-358-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO537463200Medicaid
MO0528310001Medicare NSC
MO537463200Medicaid