Provider Demographics
NPI:1902379266
Name:EL DORADO VISION LLC
Entity Type:Organization
Organization Name:EL DORADO VISION LLC
Other - Org Name:VISION SOURCE EL DORADO SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-777-9000
Mailing Address - Street 1:701 E HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744
Mailing Address - Country:US
Mailing Address - Phone:417-876-6052
Mailing Address - Fax:417-876-3352
Practice Address - Street 1:701 E HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744
Practice Address - Country:US
Practice Address - Phone:417-876-6052
Practice Address - Fax:417-876-3352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL DORADO VISION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-09
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty