Healthcare Provider Details

I. General information

NPI: 1366423766
Provider Name (Legal Business Name): CARTHAGE EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 4TH ST
CARTHAGE MO
64836-1627
US

IV. Provider business mailing address

130 E 4TH ST
CARTHAGE MO
64836-1627
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-2950
  • Fax: 417-358-4204
Mailing address:
  • Phone: 417-358-2950
  • Fax: 417-358-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TAMRA LEONA SORIANO
Title or Position: OWNER
Credential: O.D.
Phone: 417-358-2950