Organization
MOUNT VERNON EYECARE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA BURDETT (OFFICE MANAGER)
(417) 235-5250
Entity
Organization
Contact information
Practice address
104 S HICKORY, MOUNT VERNON, MO 65712
(417) 466-7620
(417) 466-7620
Mailing address
PO BOX 603, MOUNT VERNON, MO 65712-0603
(417) 466-7620
(417) 466-7622
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530524107
—
MO
Enumeration date
10/17/2006
Last updated
09/10/2010
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