MEDICARE: FAMILY EYECARE ASSOCIATES

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	T02552	MO
2	152W00000X	Optometrist	TO3452	MO
3	152W00000X	Optometrist	T02691	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

General Provider Information

NPI Number	:	1588723837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYECARE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 1887
Second Line	:
City	:	CAMDENTON
State	:	MO
Zip	:	65020-1887
Country	:	US
Telephone Number	:	573-346-5951
Fax Number	:	573-346-3252

Provider Business Practice Location Address
First Line	:	117 S. BUSINESS ROUTE 5
Second Line	:
City	:	CAMDENTON
State	:	MO
Zip	:	65020-1887
Country	:	US
Telephone Number	:	573-346-5951
Fax Number	:	573-346-3252

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DIANA MEADE SCOGGIN
Credential	:	O.D.
Telephone Number	:	573-346-5951

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	11/23/2011

Similar Medicare Providers

1407842156 — DR. DIANA MEADE SCOGGIN OD
Practice Location Address:

117 S BUSINESS ROUTE 5
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65020-1887

Practice Phone: 573-346-5951
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1821093287 — DR. DAVID LEE CATHCART M.D.
Practice Location Address:

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1477552479 — DR. MICHAEL H LEDBETTER DO
Practice Location Address:

1930 N BUSINESS ROUTE 5 , UNIT 1A
CAMDENTON, MO
65020-2659

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Practice Fax: 573-346-1957

1477549822 — N & R OF CAMDENTON, INC.
Practice Location Address:

2042 N BUSINESS ROUTE 5
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1548242894 — CAROLINE ELIZABETH CAMPBELL M.D.
Practice Location Address:

1930 N BUSINESS ROUTE 5
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65020-2659

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1346224110 — JAMES E PARKER
Practice Location Address:

802 N BUSINESS ROUTE 5
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Practice Phone: 573-346-5556
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Directions to “FAMILY EYECARE ASSOCIATES ” Practice Location

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