Provider Demographics
NPI:1366867491
Name:SPECIAL CARE VISION OF MISSOURI, LLC
Entity type:Organization
Organization Name:SPECIAL CARE VISION OF MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-244-2457
Mailing Address - Street 1:12910 SHELBYVILLE RD
Mailing Address - Street 2:300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1593
Mailing Address - Country:US
Mailing Address - Phone:502-244-2457
Mailing Address - Fax:
Practice Address - Street 1:1115 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1306
Practice Address - Country:US
Practice Address - Phone:502-244-2457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty