Organization
TRI LAKES MEDICAL AND SURGICAL EYE CLINIC, INC.
Active
Other names
TRI LAKES EYE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY R FORD (INSURANCE/BILLING COORDINATOR)
(417) 334-0044
Entity
Organization
Contact information
Practice address
915 STATE HIGHWAY 248, SUITE A, BRANSON, MO 65616-8003
(417) 334-0044
(417) 334-0046
Mailing address
915 STATE HIGHWAY 248, SUITE A, BRANSON, MO 65616-8003
(417) 334-0044
(417) 334-0046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
R6C05
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325133601
—
MO
Enumeration date
07/31/2006
Last updated
12/03/2013
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