Organization
MERCY CLINIC SPRINGFIELD COMMUNITIES
Active
Other names
Mercy Clinic Eye Specialists Optical Shop-Rolla
Organization subpart
No
Provider details
NPI number
Authorized official
STUART STANGELAND (SR. VP/COO)
(417) 820-3514
Entity
Organization
Contact information
Practice address
1605 MARTIN SPRINGS DR, SUITE 240A, ROLLA, MO 65401-2931
(573) 458-6310
(573) 458-6791
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4246
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03477
MO
152WC0802X
Corneal and Contact Management Optometrist
T03477
MO
156FX1800X
Optician
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
04/09/2012
Last updated
12/02/2015
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