Healthcare Provider Details

I. General information

NPI: 1558189084
Provider Name (Legal Business Name): LOW VISION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 S MCCANN CT STE D
SPRINGFIELD MO
65804-7232
US

IV. Provider business mailing address

4145 S MCCANN CT STE D
SPRINGFIELD MO
65804-7232
US

V. Phone/Fax

Practice location:
  • Phone: 417-598-0168
  • Fax: 417-719-7955
Mailing address:
  • Phone: 417-598-0168
  • Fax: 417-719-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224ZL0004X
TaxonomyLow Vision Occupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBRA WILLIAMS
Title or Position: OWNER
Credential: OD
Phone: 417-598-0168