Provider Demographics
NPI:1932388824
Name:BPEYES LLC
Entity Type:Organization
Organization Name:BPEYES LLC
Other - Org Name:TABLE ROCK FAMILY VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-272-8333
Mailing Address - Street 1:16282 STATE HIGHWAY 13 STE C
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737-8875
Mailing Address - Country:US
Mailing Address - Phone:417-272-8333
Mailing Address - Fax:417-272-8885
Practice Address - Street 1:16282 STATE HIGHWAY 13 STE C
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-8875
Practice Address - Country:US
Practice Address - Phone:417-272-8333
Practice Address - Fax:417-272-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4115670001Medicare NSC