Provider Demographics
NPI:1487825535
Name:ACCESS EYE CARE LLC
Entity Type:Organization
Organization Name:ACCESS EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORAL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BASS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:417-894-4759
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-0858
Mailing Address - Country:US
Mailing Address - Phone:417-581-3927
Mailing Address - Fax:417-581-3953
Practice Address - Street 1:2004 W MARLER LN
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7661
Practice Address - Country:US
Practice Address - Phone:417-581-3927
Practice Address - Fax:417-581-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013037365OtherINDIVIDUAL NPI
MO1487825535Medicaid
MO000015702OtherPTAN
MO1487825535Medicaid