Provider Demographics
NPI:1326140187
Name:DRS DAVIS JORDAN & BOWLING OPTOMETRISTS PC
Entity Type:Organization
Organization Name:DRS DAVIS JORDAN & BOWLING OPTOMETRISTS PC
Other - Org Name:OZARKS FAMILY VISION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-334-7291
Mailing Address - Street 1:1000 JAMES EPPS ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7203
Mailing Address - Country:US
Mailing Address - Phone:417-334-7291
Mailing Address - Fax:417-334-6156
Practice Address - Street 1:916-A NW 12TH AVENUE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608
Practice Address - Country:US
Practice Address - Phone:417-683-3612
Practice Address - Fax:417-683-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507305605Medicaid
MO328163001Medicaid
MOCP8347Medicare PIN
MO0420260001Medicare NSC
MO000006128Medicare ID - Type Unspecified