Healthcare Provider Details

I. General information

NPI: 1760570295
Provider Name (Legal Business Name): NEVADA OPTOMETRIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S WASHINGTON ST
NEVADA MO
64772-3330
US

IV. Provider business mailing address

PO BOX 308
NEVADA MO
64772-0308
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-2560
  • Fax:
Mailing address:
  • Phone: 417-667-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RONNIE J. HATCH
Title or Position: PRESIDENT
Credential: O.D.
Phone: 417-667-2560