McWilliams Eyecare, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

T03461 Issued in MO

Legal business name

MCWILLIAMS EYECARE, LLC

Practice address

500 Warren County Ctr
Warrenton, MO 63383-3023

Phone

(636) 456-5379

Fax

(636) 456-5410

NPI assigned

Oct 13, 2009

Organization subpart

No

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

Authorized official

Name

Kenton L McWilliams, OD

Title

Physician

Phone

(636) 456-5379

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Ira Nathan Ettinger, O.D.

  • Corneal and Contact Management Optometrist
  • Washington, MO
  • NPI 1659421303
  NPD (past)

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255392000000",
    "number": "1396070124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 ANGIE DR APT D",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633766321",
            "telephone_number": "314-276-4897",
            "fax_number": "636-390-3959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WARREN COUNTY CTR",
            "city": "WARRENTON",
            "state": "MO",
            "postal_code": "633833023",
            "telephone_number": "636-456-5379",
            "fax_number": "636-456-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCWILLIAMS EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-13",
        "last_updated": "2009-10-13",
        "status": "A",
        "authorized_official_last_name": "MCWILLIAMS",
        "authorized_official_first_name": "KENTON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "636-456-5379",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE ID",
            "identifier": "T03461",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315908707",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Wayne Mathenia
• Jay L Maturan, ATC, MAT, LAT
• Beth Maynard
• Cori McIntire, BCBA, LBA
• Jennifer Michelle McQuaide, LPC
• Kenton Lee McWilliams, O.D.
• Julie Anne Meyer, P.T.
• Amanda Rae Miller
• Kaitlyn Miller
• Janicia Mitchell, LPC

• Optometrist in Warrenton, MO
• Providers in Warrenton, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; 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.