Eyeglass Center LLC
Organization Active NPI Health Maintenance Organization · Saint Robert, MO
NPI 1992944979 · NPPES record last updated Feb 13, 2009
Key facts
- NPI
- 1992944979
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- License
- TO3060 (MO)
- Legal business name
- EYEGLASS CENTER LLC
- Practice address
- 690 Missouri Ave Ste 22
Saint Robert, MO 65584-4680 - Phone
- (573) 336-4670
- Fax
- (573) 336-5968
- NPI assigned
- Feb 13, 2009
- Organization subpart
- No
Authorized official
- Name
- Mrs. Nancy Eileen Sutton, ABOC
- Title
- Front Office Manager
- Phone
- (573) 336-4670
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090227000110 | MO | Part B Supplier - Clinic/Group Practice | 6204992241 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint Robert, MO |
National Provider Directory
Locations
690 Missouri Ave
Ste 22
Saint Robert, MO 65584
Phone (573) 336-4670
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | TO3060 | MO | Yes |
Addresses
Primary practice location
690 Missouri Ave Ste 22
Saint Robert, MO 65584-4680
Mailing address
690 Missouri Ave Ste 22
Saint Robert, MO 65584-4680
Phone (573) 336-4670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 313540411 | Medicaid | MO |
Other names
- Dr. Kamrian Sue Wilson OD
Other providers in Saint Robert, MO
- Sylvia Dawn Dittman
- Bryan H Donnelly
- Meranda Jo Ellis
- Sarah Ernst
- Melva Evans
- Karah L Ferrell
- Caitlin Marie Fincher
- Ashley Fisher
- Jessica C Flores
- Kristopher Stephen Flynt
All providers in Saint Robert, MO · Health Maintenance Organization in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.