1871867408 NPI number — HUNT & NOSACKA OPTOMETRIC GROUP P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871867408 NPI number — HUNT & NOSACKA OPTOMETRIC GROUP P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNT & NOSACKA OPTOMETRIC GROUP P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871867408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 N DOUGLASS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63863-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-276-3239
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 N DOUGLASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALDEN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63863-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-276-3239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUNT
Authorized Official First Name:
KAMRON
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
573-714-2075

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2010003758 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com