1235493164 NPI number — NORMAN PROFESSIONAL EYECARE AND CONTACT LENS CLINIC LLC

Table of content: (NPI 1235493164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235493164 NPI number — NORMAN PROFESSIONAL EYECARE AND CONTACT LENS CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN PROFESSIONAL EYECARE AND CONTACT LENS CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235493164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 DOCTORS PARK
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63703-4927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-803-2211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 DOCTORS PARK
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-803-2211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NORMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
573-803-2211

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T03491 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235493164 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com