Provider Demographics
NPI:1588723837
Name:FAMILY EYECARE ASSOCIATES
Entity type:Organization
Organization Name:FAMILY EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MEADE
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-346-5951
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-1887
Mailing Address - Country:US
Mailing Address - Phone:573-346-5951
Mailing Address - Fax:573-346-3252
Practice Address - Street 1:117 S. BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-1887
Practice Address - Country:US
Practice Address - Phone:573-346-5951
Practice Address - Fax:573-346-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02552152W00000X
MOTO3452152W00000X
MOT02691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507593101Medicaid
MOCS1078Medicare PIN
MO0201180001Medicare NSC
MO000015320Medicare PIN