Healthcare Provider Details

I. General information

NPI: 1013051390
Provider Name (Legal Business Name): SLOAN EYECARE CENTER L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S MAIN ST
BROOKFIELD MO
64628-2146
US

IV. Provider business mailing address

431 S MAIN ST
BROOKFIELD MO
64628-2146
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-7409
  • Fax: 660-258-7842
Mailing address:
  • Phone: 660-258-7409
  • Fax: 660-258-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DUANE THOMPSON
Title or Position: OWNER-MANANAGING MEMEBER
Credential: O.D.
Phone: 660-646-3937