MEDICARE: WARRENSBURG OPTICAL INC

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	04580012	OTHER	BC BS KC 8 DIGIT BILLING NUMBER
2	04580012	OTHER	BLUE CROSS BLUE SHEILD KC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801850490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARRENSBURG OPTICAL INC

Provider Business Mailing Address
First Line	:	602 N MAGUIRE ST
Second Line	:
City	:	WARRENSBURG
State	:	MO
Zip	:	64093-1420
Country	:	US
Telephone Number	:	660-747-7300
Fax Number	:	660-747-5322

Provider Business Practice Location Address
First Line	:	108 NE 2ND ST
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-8324
Country	:	US
Telephone Number	:	660-463-7915
Fax Number	:	660-463-2808

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. THOMAS W HOBBS
Credential	:	O.D.
Telephone Number	:	660-747-7300

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/10/2011

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Directions to “WARRENSBURG OPTICAL INC ” Practice Location

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