Provider Demographics
NPI:1760558019
Name:REGIONAL EYECARE CENTER, INC.
Entity Type:Organization
Organization Name:REGIONAL EYECARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-335-3937
Mailing Address - Street 1:1749 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5903
Mailing Address - Country:US
Mailing Address - Phone:573-335-3937
Mailing Address - Fax:573-334-5271
Practice Address - Street 1:1749 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5903
Practice Address - Country:US
Practice Address - Phone:573-335-3937
Practice Address - Fax:573-334-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0352370001Medicare NSC