Provider Demographics
NPI:1861478679
Name:DRS BOWLING GRIFFITH & ANTLE OPTOMETRISTS PC
Entity type:Organization
Organization Name:DRS BOWLING GRIFFITH & ANTLE OPTOMETRISTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-334-7291
Mailing Address - Street 1:1000 JAMES EPPS ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2030
Mailing Address - Country:US
Mailing Address - Phone:417-334-7291
Mailing Address - Fax:417-334-6156
Practice Address - Street 1:1000 JAMES EPPS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2030
Practice Address - Country:US
Practice Address - Phone:417-334-7291
Practice Address - Fax:417-334-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000006128OtherGROUP PTAN
MO507305605Medicaid
MO000006128Medicare ID - Type Unspecified
MO328163001Medicaid
MOCP8347Medicare PIN