Healthcare Provider Details

I. General information

NPI: 1669700514
Provider Name (Legal Business Name): PREMIER EYECARE & EYEWEAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 BLUE RIDGE EXT STE J
GRANDVIEW MO
64030-1175
US

IV. Provider business mailing address

12220 BLUE RIDGE EXT STE J
GRANDVIEW MO
64030-1175
US

V. Phone/Fax

Practice location:
  • Phone: 816-761-6337
  • Fax: 816-761-3564
Mailing address:
  • Phone: 816-761-6337
  • Fax: 816-761-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIST D DAWSON
Title or Position: OWNER,MGR,OD
Credential: OD
Phone: 816-761-6337