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General NPI Number Information
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NPI Number | 1215058243
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Entity Type | Organization
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Legal Business Name | MOBERLY EYE CENTER INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 1633 S MORLEY ST
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City | MOBERLY
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State | MO
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Zip | 65270-1938
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Country | US
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Telephone | 660-263-4261
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Fax | 660-263-0958
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Provider Business Mailing Address
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Address Line | PO BOX 696
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City | MOBERLY
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State | MO
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Zip | 65270-0696
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Country | US
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Telephone | 660-263-4261
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Fax | 660-263-0958
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID WHITSON
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Credential | OD
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Telephone | 660-263-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T03120
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License Number State | MO
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