Provider Demographics
NPI:1528006426
Name:ADVANCED EYECARE PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE PC
Other - Org Name:BLUE SPRINGS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-353-1872
Mailing Address - Street 1:1116 SW US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-4610
Mailing Address - Country:US
Mailing Address - Phone:816-229-2020
Mailing Address - Fax:816-220-2020
Practice Address - Street 1:1116 SW US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4610
Practice Address - Country:US
Practice Address - Phone:816-229-2020
Practice Address - Fax:816-220-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG 2866OtherRAILROAD MEDICARE
0185130003Medicare NSC
DG 2866OtherRAILROAD MEDICARE