Organization
EYECARE OF BOONVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF D. BIRDSONG O.D. (MANAGER)
(660) 882-2444
Entity
Organization
Contact information
Practice address
505 E WALNUT ST, BOONVILLE, MO 65233-1665
(660) 882-2444
Mailing address
505 E WALNUT ST, BOONVILLE, MO 65233-1665
(660) 882-2444
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2004017361
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219840
ANTHEM PROVIDER ID
MO
Enumeration date
08/16/2007
Last updated
09/09/2008
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