Provider Demographics
NPI:1265496855
Name:WARRENSBURG OPTICAL INC
Entity Type:Organization
Organization Name:WARRENSBURG OPTICAL INC
Other - Org Name:INSIGHT EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-747-7300
Mailing Address - Street 1:602 N MAGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1420
Mailing Address - Country:US
Mailing Address - Phone:660-747-7300
Mailing Address - Fax:660-747-5322
Practice Address - Street 1:217 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1614
Practice Address - Country:US
Practice Address - Phone:816-776-2900
Practice Address - Fax:816-776-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO321111411Medicaid
04580012OtherBC BS KC 8 DIGIT BILLING NUMBER
04580012OtherBLUE CROSS BLUE SHIELD KC
0710770002Medicare NSC
G490000BMedicare PIN
04580012OtherBLUE CROSS BLUE SHIELD KC
DA2824Medicare PIN