| 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 |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 126 S Main St, De Soto, Missouri |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922268564 | NPI | - | NPPES |
| 315698803 | Medicaid | MO | |
| 313299505 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | T02872 (Missouri) | Secondary |
| 152W00000X | Optometrist | T03075 (Missouri) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| 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 | |
Dr. Charles William Pelton, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 126 S Main St, De Soto, MO 63020 Phone: 636-586-5406 Fax: 636-586-1969 | |
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 |