Healthcare Provider Details

I. General information

NPI: 1184038127
Provider Name (Legal Business Name): OWEN SETTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 N GRETNA RD
BRANSON MO
65616-7287
US

IV. Provider business mailing address

5571 N GRETNA RD
BRANSON MO
65616-7287
US

V. Phone/Fax

Practice location:
  • Phone: 417-243-2300
  • Fax:
Mailing address:
  • Phone: 417-243-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2794
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: