Provider Demographics
NPI:1386887388
Name:HUNTRESS VISIONHEALTH ASSOCIATES LLC
Entity type:Organization
Organization Name:HUNTRESS VISIONHEALTH ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-235-2020
Mailing Address - Street 1:P.O. BOX 460
Mailing Address - Street 2:215 4TH ST
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2314
Mailing Address - Country:US
Mailing Address - Phone:417-235-2020
Mailing Address - Fax:417-235-5508
Practice Address - Street 1:215 4TH ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2314
Practice Address - Country:US
Practice Address - Phone:417-235-2020
Practice Address - Fax:417-235-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO328474101Medicaid
MO310574918Medicaid
MO311429906Medicaid
MO312853807Medicaid
MOMA2116Medicare PIN
MO328474101Medicaid
MO6382420001Medicare NSC
MO310574918Medicaid
MO0994710001Medicare NSC
MOU03237Medicare UPIN