Provider Demographics
NPI:1801850490
Name:WARRENSBURG OPTICAL INC
Entity type:Organization
Organization Name:WARRENSBURG OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-747-7300
Mailing Address - Street 1:602 N MAGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1420
Mailing Address - Country:US
Mailing Address - Phone:660-747-7300
Mailing Address - Fax:660-747-5322
Practice Address - Street 1:108 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-8324
Practice Address - Country:US
Practice Address - Phone:660-463-7915
Practice Address - Fax:660-463-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
04580012OtherBC BS KC 8 DIGIT BILLING NUMBER
04580012OtherBLUE CROSS BLUE SHEILD KC
MO321111429Medicaid
04580012OtherBC BS KC 8 DIGIT BILLING NUMBER
G490000BMedicare PIN
DA2824Medicare PIN
CD2257Medicare PIN