Healthcare Provider Details

I. General information

NPI: 1164524401
Provider Name (Legal Business Name): WILLIAM K HECOX OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N KANSAS EXPY
SPRINGFIELD MO
65803-1017
US

IV. Provider business mailing address

3846 W FARM ROAD 68
SPRINGFIELD MO
65803-6116
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-0390
  • Fax:
Mailing address:
  • Phone: 417-833-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: