Healthcare Provider Details

I. General information

NPI: 1124347513
Provider Name (Legal Business Name): EYECONIC EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18931 E VALLEY VIEW PKWY SUITE H
INDEPENDENCE MO
64055-7012
US

IV. Provider business mailing address

18931 E VALLEY VIEW PKWY SUITE H
INDEPENDENCE MO
64055-7012
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-8884
  • Fax:
Mailing address:
  • Phone: 816-795-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2004004593
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL J HAWK
Title or Position: OPTOMETRIST / OWNER
Credential: O.D.
Phone: 816-308-9132