Healthcare Provider Details

I. General information

NPI: 1255341939
Provider Name (Legal Business Name): QUALITY FAMILY EYECARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

601 E RUSSELL AVE SUITE A
WARRENSBURG MO
64093
US

IV. Provider business mailing address

601 E RUSSELL AVE SUITE A
WARRENSBURG MO
64093
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2020
  • Fax: 660-747-0574
Mailing address:
  • Phone: 660-747-2020
  • Fax: 660-747-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02785
License Number StateMO

VIII. Authorized Official

Name: DR. STEPHEN COOK
Title or Position: DOCTOR/OWNER
Credential: O.D.
Phone: 660-747-2020