Provider Demographics
NPI:1720453251
Name:EYECARE SPECIALTIES OF MISSOURI LLC
Entity type:Organization
Organization Name:EYECARE SPECIALTIES OF MISSOURI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-747-2020
Mailing Address - Street 1:601 E RUSSELL AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9605
Mailing Address - Country:US
Mailing Address - Phone:660-747-2020
Mailing Address - Fax:660-747-0574
Practice Address - Street 1:1652 SE BLUE PARKWAY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3191
Practice Address - Country:US
Practice Address - Phone:816-207-6085
Practice Address - Fax:816-600-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty