Provider Demographics
NPI:1700353851
Name:ELDON FAMILY FOCUS EYECARE LLC
Entity Type:Organization
Organization Name:ELDON FAMILY FOCUS EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-268-0468
Mailing Address - Street 1:115 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1444
Mailing Address - Country:US
Mailing Address - Phone:573-392-7126
Mailing Address - Fax:573-392-0800
Practice Address - Street 1:115 N OAK ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1444
Practice Address - Country:US
Practice Address - Phone:573-392-7126
Practice Address - Fax:573-392-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952666919Medicaid