Provider Demographics
NPI:1952501223
Name:EYE TO EYE OPTOMETRY, INC
Entity Type:Organization
Organization Name:EYE TO EYE OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:573-581-8811
Mailing Address - Street 1:321 W PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2719
Mailing Address - Country:US
Mailing Address - Phone:573-581-8811
Mailing Address - Fax:573-582-7007
Practice Address - Street 1:201 S MULDROW ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-1980
Practice Address - Country:US
Practice Address - Phone:573-581-8811
Practice Address - Fax:573-582-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313780306Medicaid
MO1318560001Medicare NSC