Provider Demographics
NPI:1003112012
Name:VISION REHABILITATION CENTER OF THE OZARKS
Entity Type:Organization
Organization Name:VISION REHABILITATION CENTER OF THE OZARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-831-0555
Mailing Address - Street 1:1661 WEST ELFINDALE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1287
Mailing Address - Country:US
Mailing Address - Phone:417-831-0555
Mailing Address - Fax:417-831-0532
Practice Address - Street 1:1661 WEST ELFINDALE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1287
Practice Address - Country:US
Practice Address - Phone:417-831-0555
Practice Address - Fax:417-831-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03116152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317857019Medicaid
MO317857001Medicaid
MO000014384Medicare PIN
MOU50298Medicare UPIN