Provider Demographics
NPI:1730370305
Name:SPRINGFIELD EYECARE, LLC
Entity type:Organization
Organization Name:SPRINGFIELD EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:PILKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:417-887-6883
Mailing Address - Street 1:2825 S GLENSTONE AVE
Mailing Address - Street 2:SUITE 113 BATTLEFIELD MALL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3732
Mailing Address - Country:US
Mailing Address - Phone:417-887-6883
Mailing Address - Fax:417-887-6884
Practice Address - Street 1:2825 S GLENSTONE AVE
Practice Address - Street 2:SUITE 113 BATTLEFIELD MALL
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3732
Practice Address - Country:US
Practice Address - Phone:417-887-6883
Practice Address - Fax:417-887-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU30682Medicare UPIN