Organization
LAKE FAMILY VISION CENTER INC
Active
Other names
Family Eyecare Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM R SCOGGIN O.D. (OPTOMETRIST OWNER)
(573) 374-5222
Entity
Organization
Contact information
Practice address
138 SOUTH MAIN, SUITE C, LAURIE, MO 65038-1185
(573) 374-5222
(573) 374-7351
Mailing address
PO BOX 1185, LAURIE, MO 65038-1185
(573) 374-5222
(573) 374-7351
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02682
MO
332H00000X
Eyewear Supplier
T02682
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0323200001
CIGNA MEDICARE
MO
Enumeration date
02/07/2007
Last updated
12/21/2007
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