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General NPI Number Information
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NPI Number | 1558216424
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Entity Type | Organization
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Legal Business Name | HEADY & PHAM ADVANCED EYECARE
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 3231 S NATIONAL AVE STE 165
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City | SPRINGFIELD
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State | MO
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Zip | 65807-7304
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Country | US
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Telephone | 314-808-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 765 E GALLUP HILL RD
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City | NIXA
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State | MO
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Zip | 65714-8864
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Country | US
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Telephone | 314-808-8450
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. RYAN JEFFREY HEADY
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Credential | OD
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Telephone | 314-808-8450
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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 |
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License Number State |
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