Organization
ST JOHNS CLINIC INC
Active
Other names
SJC-Lebanon-Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
DONN E. SORENSEN (SENIOR VICE PRESIDENT)
(417) 829-4264
Entity
Organization
Contact information
Practice address
331 HOSPITAL DR, SUITE E, LEBANON, MO 65536-9217
(417) 533-6540
(417) 533-6550
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
MO
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329095806
—
MO
Enumeration date
04/11/2007
Last updated
09/27/2011
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