Provider Demographics
NPI:1568519643
Name:SLOAN EYECARE CENTER LLC
Entity Type:Organization
Organization Name:SLOAN EYECARE CENTER LLC
Other - Org Name:PREMIER EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-MANANGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:O,D
Authorized Official - Phone:660-646-3937
Mailing Address - Street 1:1115 WASHINGTON ST
Mailing Address - Street 2:P.O. BOX 903
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1306
Mailing Address - Country:US
Mailing Address - Phone:660-646-3937
Mailing Address - Fax:660-646-4092
Practice Address - Street 1:1115 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1306
Practice Address - Country:US
Practice Address - Phone:660-646-3937
Practice Address - Fax:660-646-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4637030002Medicare NSC
MOCK8054Medicare PIN
MOL53000Medicare PIN