Provider Demographics
NPI:1760570295
Name:NEVADA OPTOMETRIC CENTER, INC.
Entity Type:Organization
Organization Name:NEVADA OPTOMETRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-667-2560
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-0308
Mailing Address - Country:US
Mailing Address - Phone:417-667-2560
Mailing Address - Fax:
Practice Address - Street 1:120 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3330
Practice Address - Country:US
Practice Address - Phone:417-667-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC710000Medicare ID - Type UnspecifiedMEDICARE
MO0406880001Medicare NSC