Provider Demographics
NPI:1770657983
Name:DYER VISION CENTER, INC
Entity Type:Organization
Organization Name:DYER VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-331-9590
Mailing Address - Street 1:5307 E 221ST ST
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-8712
Mailing Address - Country:US
Mailing Address - Phone:816-322-3829
Mailing Address - Fax:816-331-9591
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:816-331-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP540000Medicare ID - Type UnspecifiedMEDICARE FOR DYER VISION