Organization
MCCULLOUGH EYECARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAROD LANCE MCCULLOUGH O.D. (OWNER/OPTOMETRIST)
(636) 937-3130
Entity
Organization
Contact information
Practice address
202 WALNUT ST, FESTUS, MO 63028-1850
(636) 937-3130
(636) 937-7202
Mailing address
202 WALNUT ST, FESTUS, MO 63028-1850
(636) 937-3130
(636) 937-7202
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2002014341
MO
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
319118907
—
MO
01
—
DP6365
PALMETTO GBA-RR MEDICARE
MO
Enumeration date
03/05/2008
Last updated
07/05/2012
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