Organization
EYECARE SPECIALTIES OF MISSOURI LLC
Active
Other names
Eyecare Specialties
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON STEVEN LAKE OD (DR/ OWNER)
(660) 885-7116
Entity
Organization
Contact information
Practice address
1104 E OHIO ST, CLINTON, MO 64735-2458
(660) 885-7116
Mailing address
601 E RUSSELL AVE, SUITE A, WARRENSBURG, MO 64093-9605
(660) 747-2020
(660) 747-0574
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504891805
—
MO
01
—
MA5292
MEDICARE PTAN
MO
Enumeration date
08/21/2006
Last updated
04/06/2015
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