| NPI | 1679903330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET B BODENHAMER Provider 573-635-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO TO2261) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MO 2007018327) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO 2010026679) | |
| Enumeration Date | 2013-11-17 |
| Last Update Date | 2022-01-10 |