Healthcare Provider Details

I. General information

NPI: 1699020834
Provider Name (Legal Business Name): VISION CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 N 21ST ST
OZARK MO
65721-7634
US

IV. Provider business mailing address

3330 S NATIONAL AVE STE 2020
SPRINGFIELD MO
65807-7337
US

V. Phone/Fax

Practice location:
  • Phone: 417-582-2020
  • Fax: 417-582-2027
Mailing address:
  • Phone: 417-725-0500
  • Fax: 417-725-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHEN R RICE
Title or Position: PRESIDENT, CEO
Credential: OD
Phone: 417-886-5444