Healthcare Provider Details

I. General information

NPI: 1003112012
Provider Name (Legal Business Name): VISION REHABILITATION CENTER OF THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 WEST ELFINDALE
SPRINGFIELD MO
65807-1287
US

IV. Provider business mailing address

1661 WEST ELFINDALE
SPRINGFIELD MO
65807-1287
US

V. Phone/Fax

Practice location:
  • Phone: 417-831-0555
  • Fax: 417-831-0532
Mailing address:
  • Phone: 417-831-0555
  • Fax: 417-831-0532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03116
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT03116
License Number StateMO

VIII. Authorized Official

Name: MS. JACQUELINE V. CRAIG
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 417-831-0555