Provider Demographics
NPI:1942590864
Name:VISION REHABILITATION CENTER OF THE OZARKS
Entity Type:Organization
Organization Name:VISION REHABILITATION CENTER OF THE OZARKS
Other - Org Name:VISION REHABILITATION CENTER OF THE OZARKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:417-739-2411
Mailing Address - Street 1:1661 W ELFINDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1287
Mailing Address - Country:US
Mailing Address - Phone:417-831-0555
Mailing Address - Fax:417-831-0532
Practice Address - Street 1:1661 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1287
Practice Address - Country:US
Practice Address - Phone:417-831-0555
Practice Address - Fax:417-831-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03116152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty