Provider Demographics
NPI:1386036721
Name:417 EYES A SERIES LLC
Entity Type:Organization
Organization Name:417 EYES A SERIES LLC
Other - Org Name:MARSHFIELD FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-859-2010
Mailing Address - Street 1:1100 SPUR DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2261
Mailing Address - Country:US
Mailing Address - Phone:417-859-2010
Mailing Address - Fax:417-859-2038
Practice Address - Street 1:1100 SPUR DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2261
Practice Address - Country:US
Practice Address - Phone:417-859-2010
Practice Address - Fax:417-859-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty