Provider Demographics
NPI:1588680193
Name:PROFESSIONAL EYE CARE INC
Entity type:Organization
Organization Name:PROFESSIONAL EYE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-858-6080
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-1008
Mailing Address - Country:US
Mailing Address - Phone:816-858-6080
Mailing Address - Fax:816-431-6599
Practice Address - Street 1:700 BRANCH ST STE 6
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9383
Practice Address - Country:US
Practice Address - Phone:816-858-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO534003207Medicaid
MO990001639Medicare ID - Type UnspecifiedGROUP #
MOC400000BMedicare ID - Type UnspecifiedGROUP #
IL210915Medicare ID - Type UnspecifiedGROUP #
MO000091033Medicare ID - Type UnspecifiedGROUP #
ILDD7108Medicare ID - Type Unspecified
KS650513Medicare ID - Type UnspecifiedGROUP #
MOC400000Medicare ID - Type UnspecifiedGROUP MEDICARE #
MOCH5946Medicare ID - Type Unspecified
MO534003207Medicaid
MS000091034Medicare ID - Type UnspecifiedGROUP #
MO990001641Medicare ID - Type UnspecifiedGROUP #
IL210911Medicare ID - Type UnspecifiedGROUP #
MOCS9844Medicare ID - Type Unspecified
MO0480010002Medicare ID - Type UnspecifiedGROUP #
ILDD6277Medicare ID - Type Unspecified