Organization
CARTHAGE VISION CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY JOSEPH GOETZINGER O.D. (MEMBER)
(417) 359-0600
Entity
Organization
Contact information
Practice address
2020 S GARRISON AVE, CARTHAGE, MO 64836-3687
(417) 359-0600
(417) 359-0601
Mailing address
2020 S GARRISON AVE, CARTHAGE, MO 64836-3687
(417) 359-0600
(417) 359-0601
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03101
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7473660001
DMERC NORIDIAN PTAN
MO
01
—
DV9359
RAILROAD MEDICARE PTAN
MO
01
—
MA5504
MEDICARE PTAN
MO
Enumeration date
03/13/2015
Last updated
04/05/2016
Update your record
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