Healthcare Provider Details

I. General information

NPI: 1104880772
Provider Name (Legal Business Name): WARRENSBURG OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N MAGUIRE ST
WARRENSBURG MO
64093-1420
US

IV. Provider business mailing address

602 N MAGUIRE ST
WARRENSBURG MO
64093-1420
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-7300
  • Fax: 660-747-5322
Mailing address:
  • Phone: 660-747-7300
  • Fax: 660-747-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS W HOBBS
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 660-747-7300