Provider Demographics
NPI:1770763831
Name:DOCTORS ONSITE EYECARE, LLC
Entity type:Organization
Organization Name:DOCTORS ONSITE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-763-0073
Mailing Address - Street 1:3846 W FARM ROAD 68
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-6116
Mailing Address - Country:US
Mailing Address - Phone:417-763-0073
Mailing Address - Fax:877-417-7310
Practice Address - Street 1:3846 W FARM ROAD 68
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-6116
Practice Address - Country:US
Practice Address - Phone:417-763-0073
Practice Address - Fax:877-417-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty