| NPI | 1578969960 |
|---|---|
| Doing Business As | VISION SOURCE BOLIVAR |
| Entity Type | Organization |
| Authorized Contact | LAURA BETH MONTGOMERY Optometrist/Owner 417-777-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 20060182040) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2023-12-21 |