MEDICARE: ADVANCED EYE CARE OF WINFIELD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2008017063	MO
2	152W00000X	Optometrist	2007018394	MO
3	152W00000X	Optometrist	T03408	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013143957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EYE CARE OF WINFIELD LLC

Provider Business Mailing Address
First Line	:	43 ELLIS AVE
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1151
Country	:	US
Telephone Number	:	636-528-4144
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 ELLIS AVE
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1151
Country	:	US
Telephone Number	:	636-528-4144
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. DENISE M HARVEY
Credential	:	OD
Telephone Number	:	573-324-3131

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	01/27/2020

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