Healthcare Provider Details

I. General information

NPI: 1245278753
Provider Name (Legal Business Name): BETHANY EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 MILLER ST
BETHANY MO
64424-2704
US

IV. Provider business mailing address

2707 MILLER ST
BETHANY MO
64424-2704
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-8116
  • Fax:
Mailing address:
  • Phone: 660-425-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY JOSEPH VERACHTERT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 660-425-8116