Provider Demographics
NPI:1013051390
Name:SLOAN EYECARE CENTER L.L.C
Entity type:Organization
Organization Name:SLOAN EYECARE CENTER L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANANAGING MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-646-3937
Mailing Address - Street 1:431 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2146
Mailing Address - Country:US
Mailing Address - Phone:660-258-7409
Mailing Address - Fax:660-258-7842
Practice Address - Street 1:431 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2146
Practice Address - Country:US
Practice Address - Phone:660-258-7409
Practice Address - Fax:660-258-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507600203Medicaid
MO4637030003Medicare NSC
MO990001686Medicare PIN
MOCJ5425Medicare PIN