Provider Demographics
NPI:1992944979
Name:EYEGLASS CENTER LLC
Entity type:Organization
Organization Name:EYEGLASS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:573-336-4670
Mailing Address - Street 1:690 MISSOURI AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-4680
Mailing Address - Country:US
Mailing Address - Phone:573-336-4670
Mailing Address - Fax:573-336-5968
Practice Address - Street 1:690 MISSOURI AVE STE 22
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4680
Practice Address - Country:US
Practice Address - Phone:573-336-4670
Practice Address - Fax:573-336-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3060302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313540411Medicaid
MO313540411Medicaid
MOU34724Medicare UPIN