MEDICARE: DR. THOMAS G JUNK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TO2991	MO

General Provider Information

NPI Number	:	1770769499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS G JUNK O.D.

Provider Business Mailing Address
First Line	:	3439 WILLIAM ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-9507
Country	:	US
Telephone Number	:	573-335-2787
Fax Number	:	573-335-3856

Provider Business Practice Location Address
First Line	:	3439 WILLIAM ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-9507
Country	:	US
Telephone Number	:	573-335-2787
Fax Number	:	573-335-3856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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