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General NPI Number Information
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NPI Number | 1598067902
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Entity Type | Organization
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Legal Business Name | INNOVATIVE VISION CARE, LLC
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 101 APPLE VALLEY PKWY
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City | BELTON
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State | MO
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Zip | 64012-4725
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Country | US
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Telephone | 816-331-9590
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Fax | 816-368-9281
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Provider Business Mailing Address
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Address Line | 101 APPLE VALLEY PKWY
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City | BELTON
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State | MO
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Zip | 64012-4725
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Country | US
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Telephone | 816-331-9590
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Fax | 816-368-9281
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Authorized Official
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Title or Position | OWNER
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Name | AARON S LAW
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Credential | O.D.
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Telephone | 816-331-9590
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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 | 2008017076
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License Number State | MO
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