Advance Eyecare Associates LLC
Organization Active NPI Optometrist · Joplin, MO
NPI 1275707887 · NPPES record last updated Dec 20, 2010
Key facts
- NPI
- 1275707887
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2002002924 (MO)
- Legal business name
- ADVANCE EYECARE ASSOCIATES LLC
- Practice address
- 5832 N Main St
Joplin, MO 64801-9611 - Phone
- (417) 623-7900
- Fax
- (417) 623-0559
- NPI assigned
- Apr 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Eldon R Repsher, O.D.
- Title
- Owner/Optometrist
- Phone
- (417) 392-0715
Practitioners 1
-
Eldon R Repsher, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040830000003 | MO | Part B Supplier - Clinic/Group Practice | 0446225965 |
Receives reassigned benefits from 1 practitioner Practice locations: Joplin, MO |
National Provider Directory
Locations
5832 N Main St
Joplin, MO 64801
Phone (417) 623-7900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2002002924 | MO | Yes |
Addresses
Primary practice location
5832 N Main St
Joplin, MO 64801-9611
Mailing address
317 Briarbrook Dr
Carl Junction, MO 64834-9595
Phone (417) 623-7900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 318449014 | Medicaid | MO | |
| 190561 | Other | MO | BC/BS |
Other providers in Joplin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.