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General NPI Number Information
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NPI Number | 1508875790
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Entity Type | Organization
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Legal Business Name | MISSOURI EYE AND VISION ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 117 S BUSINESS ROUTE 5
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City | CAMDENTON
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State | MO
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Zip | 65020-9589
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Country | US
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Telephone | 573-346-5951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1887
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City | CAMDENTON
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State | MO
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Zip | 65020-1887
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Country | US
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Telephone | 573-346-5951
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN EVELAND
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Credential | OD
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Telephone | 573-745-0419
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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 | T03452
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License Number State | MO
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