Provider Demographics
NPI:1275730038
Name:MY EYE DOCTOR, LLC
Entity Type:Organization
Organization Name:MY EYE DOCTOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GUNNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-263-5885
Mailing Address - Street 1:1301 E HIGHWAY 24
Mailing Address - Street 2:INSIDE WAL-MART VISION CENTER
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3683
Mailing Address - Country:US
Mailing Address - Phone:660-263-5885
Mailing Address - Fax:660-263-2362
Practice Address - Street 1:1301 E HIGHWAY 24
Practice Address - Street 2:INSIDE WAL-MART VISION CENTER
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3683
Practice Address - Country:US
Practice Address - Phone:660-263-5885
Practice Address - Fax:660-263-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty