Provider Demographics
NPI:1225047897
Name:THE L.O.E. COMPANY
Entity Type:Organization
Organization Name:THE L.O.E. COMPANY
Other - Org Name:EYECARE SPECIALTIES/PRIVATE EYES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-747-2000
Mailing Address - Street 1:601 E. RUSSELL, SUITE A
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093
Mailing Address - Country:US
Mailing Address - Phone:660-747-2000
Mailing Address - Fax:660-747-0574
Practice Address - Street 1:601 E. RUSSELL, SUITE A
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:660-747-2000
Practice Address - Fax:660-747-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU71620Medicare UPIN
MOM830000Medicare ID - Type UnspecifiedGROUP #