Provider Demographics
NPI:1386750107
Name:THE EYE GALLERY COMPANY
Entity type:Organization
Organization Name:THE EYE GALLERY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:MCHARGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-808-5087
Mailing Address - Street 1:2308 BERRYVIEW CT.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-446-0956
Mailing Address - Fax:
Practice Address - Street 1:3301 BROADWAY BUSINESS PARK COURT STE. E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-446-1600
Practice Address - Fax:573-446-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006021778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty