Lake Family Vision Center Inc
Organization Active NPI Optometrist · Laurie, MO
NPI 1720128713 · NPPES record last updated Dec 21, 2007
Key facts
- NPI
- 1720128713
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- T02682 (MO)
- Legal business name
- LAKE FAMILY VISION CENTER INC
- Practice address
- 138 South Main
Suite C
Laurie, MO 65038-1185 - Phone
- (573) 374-5222
- Fax
- (573) 374-7351
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. William R Scoggin, O.D.
- Title
- Optometrist Owner
- Phone
- (573) 374-5222
Practitioners 6
-
Thomas A Dettmer, O.D.
-
Brian Eveland, OD
-
John A Gazaway, OD
-
Lisa K. Groves, OD
-
Brad Engelbarts, OD
-
Rachel E Engelbarts, O.D.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | T02682 | MO | Yes |
| Eyewear Supplier | 332H00000X | T02682 | MO |
Addresses
Primary practice location
138 South Main
Suite C
Laurie, MO 65038-1185
Mailing address
PO Box 1185
Laurie, MO 65038-1185
Phone (573) 374-5222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0323200001 | Other | MO | CIGNA MEDICARE |
Other names
- Family Eyecare Associates
Other providers in Laurie, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.