MEDICARE: MONTGOMERY OPTICS, 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	2006018240	MO

General Provider Information

NPI Number	:	1831384908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY OPTICS, LLC

Provider Business Mailing Address
First Line	:	1423 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-582-2020
Fax Number	:	417-582-2027

Provider Business Practice Location Address
First Line	:	1423 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-582-2020
Fax Number	:	417-582-2027

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. LAURA BETH MONTGOMERY
Credential	:	O.D.
Telephone Number	:	417-582-2020

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	11/10/2010

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