Provider Demographics
NPI:1508875790
Name:MISSOURI EYE AND VISION ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MISSOURI EYE AND VISION ASSOCIATES, INC.
Other - Org Name:WAL-MART VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-745-0419
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-1887
Mailing Address - Country:US
Mailing Address - Phone:573-346-5951
Mailing Address - Fax:
Practice Address - Street 1:117 S BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-9589
Practice Address - Country:US
Practice Address - Phone:573-346-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty