Provider Demographics
NPI:1750952941
Name:VANOVER VISION LLC
Entity type:Organization
Organization Name:VANOVER VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-693-9512
Mailing Address - Street 1:1515 S FORREST HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2318
Mailing Address - Country:US
Mailing Address - Phone:417-693-9512
Mailing Address - Fax:
Practice Address - Street 1:279 N EASTGATE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-512-8954
Practice Address - Fax:417-512-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty