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General NPI Number Information
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NPI Number | 1366867491
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Entity Type | Organization
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Legal Business Name | SPECIAL CARE VISION OF MISSOURI, LLC
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 1115 WASHINGTON ST
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-1306
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Country | US
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Telephone | 502-244-2457
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Fax |
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Provider Business Mailing Address
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Address Line | 12910 SHELBYVILLE RD 300
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City | LOUISVILLE
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State | KY
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Zip | 40243-1593
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Country | US
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Telephone | 502-244-2457
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | JESSICA VELTEN
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Credential | CPC
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Telephone | 502-244-2457
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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 | T02343
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License Number State | MO
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