Provider Demographics
NPI:1801992573
Name:SMITHVILLE EYE CENTER LLC
Entity type:Organization
Organization Name:SMITHVILLE EYE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:888-749-7755
Mailing Address - Street 1:1000 S 169 HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9322
Mailing Address - Country:US
Mailing Address - Phone:888-749-7755
Mailing Address - Fax:816-817-1519
Practice Address - Street 1:1000 S 169 HWY
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9322
Practice Address - Country:US
Practice Address - Phone:816-873-0202
Practice Address - Fax:816-817-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV02185Medicare UPIN
MO5809270001Medicare NSC