Healthcare Provider Details

I. General information

NPI: 1558342808
Provider Name (Legal Business Name): STEPHEN R RICE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 S NATIONAL AVE
SPRINGFIELD MO
65807-7307
US

IV. Provider business mailing address

4476 E FARM ROAD 166
SPRINGFIELD MO
65809-4232
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-5444
  • Fax: 417-725-0502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: