NPIMap

Organization Active NPI

Eyecare Specialties of Missouri LLC

Doing business as Eyecare Specialties

  • Optometrist
  • Clinton, MO
National Provider Identifier
1053427435
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARE SPECIALTIES OF MISSOURI LLC
Doing business as
Eyecare Specialties
Practice address
1104 E Ohio St
Clinton, MO 64735-2458
Phone
(660) 885-7116
NPI assigned
Aug 21, 2006
Last updated
Apr 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jason Steven Lake, ODNPI 1629022777
Title
Dr/ Owner
Phone
(660) 885-7116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1104 E Ohio St
Clinton, MO 64735-2458

Mailing address

601 E Russell Ave
Suite a
Warrensburg, MO 64093-9605
Phone (660) 747-2020

Other identifiers 2

IdentifierTypeStateIssuer
504891805MedicaidMO
MA5292OtherMOMEDICARE PTAN

Other names 1

  • Eyecare Specialties Doing business as

National Provider Directory

National Provider Directory

Locations

1104 E Ohio St
Clinton, MO 64735
Phone (660) 747-2020

601 E Russell Ave
Ste A
Warrensburg, MO 64093
Phone (660) 747-2000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428278400000",
    "number": "1053427435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E RUSSELL AVE",
            "address_2": "SUITE A",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640939605",
            "telephone_number": "660-747-2020",
            "fax_number": "660-747-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 E OHIO ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647352458",
            "telephone_number": "660-885-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE SPECIALTIES OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2015-04-06",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "DR/ OWNER",
        "authorized_official_telephone_number": "660-885-7116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504891805",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA5292",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.