Organization
ADVANCED EYECARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD C WILSON OD (OWNER)
(816) 353-1872
Entity
Organization
Contact information
Practice address
6708 RAYTOWN RD, RAYTOWN, MO 64133-5272
(816) 353-1872
(816) 353-5022
Mailing address
6708 RAYTOWN RD, RAYTOWN, MO 64133-5272
(816) 353-1872
(816) 353-5022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2419
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0185130001
DMERC
—
01
—
DG 2866
RAILROAD MEDICARE
—
Enumeration date
05/31/2006
Last updated
04/15/2019
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