Provider Demographics
NPI:1962658971
Name:DEXTER FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:DEXTER FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-614-5393
Mailing Address - Street 1:223 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-1767
Mailing Address - Country:US
Mailing Address - Phone:573-614-5393
Mailing Address - Fax:573-614-5639
Practice Address - Street 1:223 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1767
Practice Address - Country:US
Practice Address - Phone:573-614-5393
Practice Address - Fax:573-614-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017078261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center