NPIMap

Organization Active NPI

Central Missouri Vision Center

  • Optometrist
  • Jefferson City, MO
National Provider Identifier
1104924992
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CENTRAL MISSOURI VISION CENTER
Practice address
1445 Christy Dr Ste a
Jefferson City, MO 65101-2853
Phone
(573) 659-5560
Fax
(573) 659-5561
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Jessica Ann McEntire
Title
Manager
Phone
(573) 659-5560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1445 Christy Dr Ste a
Jefferson City, MO 65101-2853

Mailing address

1445 Christy Dr Ste a
Jefferson City, MO 65101-2853
Phone (573) 659-5560

Other names 1

  • Central Missouri Eyecare Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070103000195 MO Part B Supplier - Clinic/Group Practice 4183624893 Receives reassigned benefits from 3 practitioners
Practice locations: Jefferson City, MO

National Provider Directory

National Provider Directory
Tax ID family
Central Missouri Eyecare Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1445 Christy Dr
#A
Jefferson Cty, MO 65101
Phone (573) 659-5560

1705 Christy Dr
Ste 208
Jefferson Cty, MO 65101
Phone (573) 644-9955

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1104924992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR STE A",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-659-5560",
            "fax_number": "573-659-5561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR STE A",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-659-5560",
            "fax_number": "573-659-5561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSOURI VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "MCENTIRE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-659-5560"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Missouri Eyecare Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Missouri Eyecare Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.