Provider Demographics
NPI:1588993661
Name:OREAR OPTOMETRY P C
Entity type:Organization
Organization Name:OREAR OPTOMETRY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OREAR
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:417-255-0425
Mailing Address - Street 1:1027 PORTER WAGONER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2101
Mailing Address - Country:US
Mailing Address - Phone:417-255-0425
Mailing Address - Fax:
Practice Address - Street 1:1310 PREACHER ROE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2938
Practice Address - Country:US
Practice Address - Phone:417-255-0425
Practice Address - Fax:417-257-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000009260Medicare PIN