Provider Demographics
NPI:1871608265
Name:LALLY VISION CARE, P.C.
Entity type:Organization
Organization Name:LALLY VISION CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-524-1616
Mailing Address - Street 1:101 NE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2037
Mailing Address - Country:US
Mailing Address - Phone:816-524-1616
Mailing Address - Fax:816-524-7868
Practice Address - Street 1:101 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2037
Practice Address - Country:US
Practice Address - Phone:816-524-1616
Practice Address - Fax:816-524-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM870000Medicare ID - Type Unspecified