Advanced Eyecare PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2419 Issued in MO

Legal business name

ADVANCED EYECARE PC

Practice address

6708 Raytown Rd
Raytown, MO 64133-5272

Phone

(816) 353-1872

Fax

(816) 353-5022

NPI assigned

May 31, 2006

Last updated

Apr 15, 2019By 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

Richard C Wilson, ODNPI 1538143540

Title

Owner

Phone

(816) 353-1872

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Richard C Wilson, OD

  • Optometrist
  • Raytown, MO
  • NPI 1538143540
  Authorized official Same address or phone
• Melissa Marie Enevoldsen, O.D.

  • Optometrist
  • Blue Springs, MO
  • NPI 1396092961
  NPD (past)
• Dana Janel Krause, O.D.

  • Optometrist
  • Raytown, MO
  • NPI 1083639157
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1679510655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6708 RAYTOWN RD",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641335272",
            "telephone_number": "816-353-1872",
            "fax_number": "816-353-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6708 RAYTOWN RD",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641335272",
            "telephone_number": "816-353-1872",
            "fax_number": "816-353-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-353-1872",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0185130001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG 2866",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.