Provider Demographics
NPI:1871751974
Name:JARVIS FAMILY EYE CENTER, LLC
Entity type:Organization
Organization Name:JARVIS FAMILY EYE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-742-2733
Mailing Address - Street 1:302 PROCTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9144
Mailing Address - Country:US
Mailing Address - Phone:508-837-3790
Mailing Address - Fax:417-742-2237
Practice Address - Street 1:302 PROCTER RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9144
Practice Address - Country:US
Practice Address - Phone:417-742-2733
Practice Address - Fax:417-742-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317178408Medicaid
MO5499110001Medicare NSC
MO000014770Medicare PIN