Healthcare Provider Details

I. General information

NPI: 1134077472
Provider Name (Legal Business Name): WILES EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MARTIN SPRINGS DR STE 240A
ROLLA MO
65401-2980
US

IV. Provider business mailing address

1605 MARTIN SPRINGS DR STE 240A
ROLLA MO
65401-2980
US

V. Phone/Fax

Practice location:
  • Phone: 573-204-4197
  • Fax: 573-204-4198
Mailing address:
  • Phone: 573-204-4197
  • Fax: 573-204-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DUSTIN J WILES
Title or Position: OWNER
Credential: OD
Phone: 573-330-5925