De Soto Eye Care Llc | |
126 S Main St, De Soto, MO 63020-2104 | |
(636) 586-5406 | |
(636) 586-1969 |
Full Name | De Soto Eye Care Llc |
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Type | Facility |
Speciality | Optometrist |
Location | 126 S Main St, De Soto, Missouri |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1922268564 | NPI | - | NPPES |
315698803 | Medicaid | MO | |
313299505 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | T03075 (Missouri) | Primary |
152W00000X | Optometrist | T02872 (Missouri) | Secondary |
Provider Name | Douglas J Mcguire |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1013998707 PECOS PAC ID: 9638244379 Enrollment ID: I20080815000064 |
Mailing Address | Practice Location Address |
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De Soto Eye Care Llc 126 S Main St, De Soto, MO 63020-2104 Ph: (636) 586-5406 | De Soto Eye Care Llc 126 S Main St, De Soto, MO 63020-2104 Ph: (636) 586-5406 |
Renee Kathleen Lane, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 12862 State Route 21, De Soto, MO 63020 Phone: 636-586-9745 Fax: 636-586-0901 | |
Gennadiy Dameshek, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 126 S Main St, De Soto, MO 63020 Phone: 636-586-5406 | |
Thomas L. Monje, O.d. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 26 Jefferson Sq, De Soto, MO 63020 Phone: 636-586-2626 Fax: 636-586-2700 |