Provider Demographics
NPI:1992903660
Name:SOUTHWEST OZARK OPTOMETRIC PHYSICIANS INC
Entity type:Organization
Organization Name:SOUTHWEST OZARK OPTOMETRIC PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HOODKIRAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-276-6254
Mailing Address - Street 1:508 E PETTY LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-9291
Mailing Address - Country:US
Mailing Address - Phone:417-276-6254
Mailing Address - Fax:417-667-2707
Practice Address - Street 1:2451 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-9123
Practice Address - Country:US
Practice Address - Phone:417-777-7662
Practice Address - Fax:417-777-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty