Healthcare Provider Details

I. General information

NPI: 1689845323
Provider Name (Legal Business Name): HART FAMILY EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N KENTUCKY AVE
WEST PLAINS MO
65775-2023
US

IV. Provider business mailing address

808 N KENTUCKY AVE
WEST PLAINS MO
65775-2023
US

V. Phone/Fax

Practice location:
  • Phone: 417-255-2010
  • Fax:
Mailing address:
  • Phone: 417-255-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2006018277
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2006018277
License Number StateMO

VIII. Authorized Official

Name: JULIE A HART
Title or Position: OWNER
Credential: O.D.
Phone: 417-255-2010