Carthage Eye Care PC
Organization Active NPI Optometrist · Carthage, MO
NPI 1366423766 · NPPES record last updated Mar 9, 2018
Key facts
- NPI
- 1366423766
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- CARTHAGE EYE CARE PC
- Practice address
- 130 E 4TH St
Carthage, MO 64836-1627 - Phone
- (417) 358-2950
- Fax
- (417) 358-4204
- NPI assigned
- Nov 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Tamra Leona Soriano, O.D.
- Title
- Owner
- Phone
- (417) 358-2950
Practitioners 4
-
Michelle Lea Pyle, O.D.
-
Tamra Leona Soriano, O.D.
-
Victoria Bounous, OD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Carthage Eye Care PC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100701000650 | MO | Part B Supplier - Clinic/Group Practice | 6204967458 |
Receives reassigned benefits from 4 practitioners Practice locations: Carthage, MO |
| O20100930014289 | MO | DME Supplier - Physician - Optometrist | 6204967458 | Practice locations: Carthage, MO |
National Provider Directory
Locations
130 E 4th St
Carthage, MO 64836
Phone (417) 358-2950
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
130 E 4TH St
Carthage, MO 64836-1627
Mailing address
130 E 4TH St
Carthage, MO 64836-1627
Phone (417) 358-2950
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 537463200 | Medicaid | MO |
Other providers in Carthage, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2018. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.