Healthcare Provider Details

I. General information

NPI: 1225047897
Provider Name (Legal Business Name): THE L.O.E. COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E. RUSSELL, SUITE A
WARRENSBURG MO
64093
US

IV. Provider business mailing address

601 E. RUSSELL, SUITE A
WARRENSBURG MO
64093
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2000
  • Fax: 660-747-0574
Mailing address:
  • Phone: 660-747-2000
  • Fax: 660-747-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3409
License Number StateMO

VIII. Authorized Official

Name: JASON STEVEN LAKE
Title or Position: OWNER
Credential: O.D.
Phone: 660-747-2000