Provider Demographics
NPI:1053458380
Name:PRIMARY EYE CARE ASSOCIATES
Entity Type:Organization
Organization Name:PRIMARY EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-888-5896
Mailing Address - Street 1:303 TEACO RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3237
Mailing Address - Country:US
Mailing Address - Phone:573-888-5896
Mailing Address - Fax:573-888-1501
Practice Address - Street 1:303 TEACO RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3237
Practice Address - Country:US
Practice Address - Phone:573-888-5896
Practice Address - Fax:573-888-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02701305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO191843OtherBLUE CROSS BLUE SHIELD
MO5514370001OtherCIGNA GOVERNMENT
MO191843OtherBLUE CROSS BLUE SHIELD