NPIMap

Organization Active NPI

Eyecare Specialties of Missouri LLC

Doing business as Eyecare Specialties

  • Optometrist
  • Sedalia, MO
National Provider Identifier
1053482711
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02629 Issued in MO
Legal business name
EYECARE SPECIALTIES OF MISSOURI LLC
Doing business as
Eyecare Specialties
Practice address
3403 W 10TH St
Sedalia, MO 65301-2112
Phone
(660) 826-6161
Fax
(660) 826-8197
NPI assigned
Nov 13, 2006
Last updated
Jul 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

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

Authorized official

Name
Brett H Liesemeyer, ODNPI 1225117518
Title
Owner
Phone
(660) 826-6161

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 T02629 MO Primary

Addresses

Primary practice location

3403 W 10TH St
Sedalia, MO 65301-2112

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
312338908MedicaidMO

Other names 1

  • Eyecare Specialties Doing business as

National Provider Directory

National Provider Directory

Locations

2200 Forum Blvd
Ste 102
Columbia, MO 65203
Phone (573) 445-8780

3403 W 10th St
Sedalia, MO 65301
Phone (660) 826-6161

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435795200000",
    "number": "1053482711",
    "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": "3403 W 10TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012112",
            "telephone_number": "660-826-6161",
            "fax_number": "660-826-8197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE SPECIALTIES OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2015-07-02",
        "status": "A",
        "authorized_official_last_name": "LIESEMEYER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-826-6161",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312338908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sedalia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.