Provider Demographics
NPI:1275707887
Name:ADVANCE EYECARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADVANCE EYECARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:REPSHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-392-0715
Mailing Address - Street 1:317 BRIARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-9595
Mailing Address - Country:US
Mailing Address - Phone:417-623-7900
Mailing Address - Fax:417-623-0559
Practice Address - Street 1:5832 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9611
Practice Address - Country:US
Practice Address - Phone:417-623-7900
Practice Address - Fax:417-623-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318449014Medicaid
MO190561OtherBC/BS
MO318449014Medicaid
MO000014253Medicare PIN