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General NPI Number Information
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NPI Number | 1992903660
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Entity Type | Organization
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Legal Business Name | SOUTHWEST OZARK OPTOMETRIC PHYSICIANS INC
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Dates
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Enumeration Date | 07/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2451 S SPRINGFIELD AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-9123
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Country | US
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Telephone | 417-777-7662
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Fax | 417-777-6917
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Provider Business Mailing Address
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Address Line | 508 E PETTY LN
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City | STOCKTON
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State | MO
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Zip | 65785-9291
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Country | US
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Telephone | 417-276-6254
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Fax | 417-667-2707
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ALISON LEIGH HOODKIRAR
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Credential | OD
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Telephone | 417-276-6254
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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 | 2003015541
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License Number State | MO
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