Organization
GRACIE CHASE AVERY, LLC
Active
Other names
4States Vision Express
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MICHAEL GARDNER OD (OWNER)
(417) 499-7715
Entity
Organization
Contact information
Practice address
1701 W 26TH ST STE E, JOPLIN, MO 64804-1513
(417) 925-2366
(417) 925-2367
Mailing address
1701 W 26TH ST STE E, JOPLIN, MO 64804-1513
(417) 925-2366
(417) 925-2367
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03487
MO
Other
Enumeration date
11/20/2017
Last updated
10/16/2020
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