Healthcare Provider Details

I. General information

NPI: 1023597127
Provider Name (Legal Business Name): EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 W FOXWOOD DRIVE
RAYMORE MO
64083
US

IV. Provider business mailing address

4801 S CLIFF AVE STE 100
INDEPENDENCE MO
64055-6954
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax:
Mailing address:
  • Phone: 816-350-4536
  • Fax: 816-350-4585

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: MELINDA HAMILTON
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 816-350-4536