| Organization Name: | IMAGE EYE CARE, LLC |
| NPI Number: | 1073896452 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TODD P. HAMILTON (OWNER) |
| Mailing Address: | 1120 Wolfrum Rd Ste. 106 Weldon Spring |
| State: | MO US |
| Postal Code: | 633047898 |
| Phone Number: | 6364472244 |
| Fax Number: | |
| NPI Enumeration Date: | 09/22/2011 |
| NPI Last Update Date: | 09/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2000160793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |