Provider Demographics
NPI:1548591837
Name:EYE CLINIC LLC
Entity Type:Organization
Organization Name:EYE CLINIC LLC
Other - Org Name:KEVIN K CARL, O.D. DBA EYE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-378-6646
Mailing Address - Street 1:506 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1068
Mailing Address - Country:US
Mailing Address - Phone:573-378-6646
Mailing Address - Fax:573-378-6864
Practice Address - Street 1:506 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1068
Practice Address - Country:US
Practice Address - Phone:573-378-6646
Practice Address - Fax:573-378-6864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-26
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6375900001Medicare NSC