Tri Lakes Medical and Surgical Eye Clinic, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

R6C05 Issued in MO

Legal business name

TRI LAKES MEDICAL AND SURGICAL EYE CLINIC, INC.

Doing business as

Tri Lakes Eye Center

Practice address

915 State Highway 248
Suite a
Branson, MO 65616-8003

Phone

(417) 334-0044

Fax

(417) 334-0046

NPI assigned

Jul 31, 2006

Last updated

Dec 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy R Ford

Title

Insurance/Billing Coordinator

Phone

(417) 334-0044

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• TRI LAKES EYE CENTER Doing business as

Locations

Practitioners 1

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.

• Debra Lynne Williams, O.D.

  • Low Vision Rehabilitation Optometrist
  • Springfield, MO
  • NPI 1215931886
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1497760854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 STATE HIGHWAY 248",
            "address_2": "SUITE A",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656168003",
            "telephone_number": "417-334-0044",
            "fax_number": "417-334-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 STATE HIGHWAY 248",
            "address_2": "SUITE A",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656168003",
            "telephone_number": "417-334-0044",
            "fax_number": "417-334-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI LAKES MEDICAL AND SURGICAL EYE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "INSURANCE/BILLING COORDINATOR",
        "authorized_official_telephone_number": "417-334-0044"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "R6C05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "325133601",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRI LAKES EYE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bonnie M Todd, FNP
• Ryan D Toliver, PA-C
• TP Branson Ops LLC (Total Point Urgent Care)
• Hoa Thi Mai Tran
• Transformed Psychiatric Wellness LLC
• Tri-Lakes Anesthesia, LLC
• Tri-Lakes Chiropractic Clinic P C
• Tri-Lakes Church (Tri-Lakes Relational Center)
• Tri-Lakes Diagnostic Imaging, LLC
• Tri-Lakes Diagnostic Tech.

• Ophthalmology Physician in Branson, MO
• Providers in Branson, MO by specialty
• Ophthalmology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; 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.