NPIMap

Organization Active NPI

Eyecare Specialties of Missouri LLC

  • Optometrist
  • Warrensburg, MO
National Provider Identifier
1730596248
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARE SPECIALTIES OF MISSOURI LLC
Practice address
601 E Russell Ave
Suite a
Warrensburg, MO 64093-9605
Phone
(660) 747-2020
Fax
(660) 747-0574
NPI assigned
Jul 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name
Miss Nicole E Gaither
Title
Insurance Dept.
Phone
(660) 885-7116

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X

Addresses

Primary practice location

601 E Russell Ave
Suite a
Warrensburg, MO 64093-9605

Mailing address

601 E Russell Ave
Suite a
Warrensburg, MO 64093-9605
Phone (660) 747-2020

Other names 1

  • Eyecare Specialites Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141125002051 MO Part B Supplier - Clinic/Group Practice 9931421187 Receives reassigned benefits from 15 practitioners
Practice locations: Belton, MO; Clinton, MO; Columbia, MO; Lees Summit, MO; Sedalia, MO; Warrensburg, MO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1104 E Ohio St
Clinton, MO 64735
Phone (660) 885-7116

2200 Forum Blvd
Ste 102
Columbia, MO 65203
Phone (573) 445-8780

3403 W 10th St
Sedalia, MO 65301
Phone (660) 826-6161

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1730596248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E RUSSELL AVE",
            "address_2": "SUITE A",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640939605",
            "telephone_number": "660-747-2020",
            "fax_number": "660-747-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E RUSSELL AVE",
            "address_2": "SUITE A",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640939605",
            "telephone_number": "660-747-2020",
            "fax_number": "660-747-0574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE SPECIALTIES OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "GAITHER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "INSURANCE DEPT.",
        "authorized_official_telephone_number": "660-885-7116",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Specialites",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrensburg, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; 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.