Provider Demographics
NPI:1598067902
Name:INNOVATIVE VISION CARE, LLC
Entity Type:Organization
Organization Name:INNOVATIVE VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-331-9590
Mailing Address - Street 1:101 APPLE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4725
Mailing Address - Country:US
Mailing Address - Phone:816-331-9590
Mailing Address - Fax:816-368-9281
Practice Address - Street 1:101 APPLE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4725
Practice Address - Country:US
Practice Address - Phone:816-331-9590
Practice Address - Fax:816-368-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2901Medicare PIN