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General NPI Number Information
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NPI Number | 1588993661
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Entity Type | Organization
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Legal Business Name | OREAR OPTOMETRY P C
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 1310 PREACHER ROE BLVD
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City | WEST PLAINS
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State | MO
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Zip | 65775-2938
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Country | US
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Telephone | 417-255-0425
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Fax | 417-257-2815
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Provider Business Mailing Address
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Address Line | 1027 PORTER WAGONER BLVD STE 300
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City | WEST PLAINS
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State | MO
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Zip | 65775-2101
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Country | US
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Telephone | 417-255-0425
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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. STACY LEE OREAR
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Credential | O. D.
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Telephone | 417-255-0425
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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 | TO3218
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License Number State | MO
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