Eyecare of Boonville, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2004017361 Issued in MO

Legal business name

EYECARE OF BOONVILLE, LLC

Practice address

505 E Walnut St
Boonville, MO 65233-1665

Phone

(660) 882-2444

NPI assigned

Aug 16, 2007

Organization subpart

No

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

Authorized official

Name

Jeff D. Birdsong, O.D.NPI 1790777191

Title

Manager

Phone

(660) 882-2444

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

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

• Jeff Birdsong, O.D.

  • Optometrist
  • Boonville, MO
  • NPI 1790777191

  MO, Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1669664280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E WALNUT ST",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652331665",
            "telephone_number": "660-882-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E WALNUT ST",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652331665",
            "telephone_number": "660-882-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE OF BOONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "BIRDSONG",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "660-882-2444",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2004017361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER ID",
            "identifier": "219840",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elise Welsh DNP, LLC
• Sally J Ellebracht-Gerke, M.D.
• Brittney Fay Ellington, PHARMD
• Eric Elliott, MSN-APRN
• Excel Physical Therapy & Sports Medicine Clinic
• Family Counseling Center of Missouri, Inc.
• John Douglas Foster II, RN
• Lyndi Geha
• Elyssa Ann Gibbons, DPT
• Sammy H Goedrich, OTR

• All providers in Boonville, MO
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; 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.