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General NPI Number Information
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NPI Number | 1952501223
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Entity Type | Organization
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Legal Business Name | EYE TO EYE OPTOMETRY, INC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 201 S MULDROW ST
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City | MEXICO
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State | MO
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Zip | 65265-1980
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Country | US
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Telephone | 573-581-8811
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Fax | 573-582-7007
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Provider Business Mailing Address
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Address Line | 321 W PROMENADE ST
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City | MEXICO
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State | MO
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Zip | 65265-2719
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Country | US
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Telephone | 573-581-8811
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Fax | 573-582-7007
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. JAMES WILLIAMS
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Credential | MBA
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Telephone | 573-581-8811
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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 | T03285
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License Number State | MO
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