Healthcare Provider Details

I. General information

NPI: 1407842156
Provider Name (Legal Business Name): DIANA MEADE SCOGGIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DIANA LYNNE MEADE

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S BUSINESS ROUTE 5
CAMDENTON MO
65020-1887
US

IV. Provider business mailing address

PO BOX 1887
CAMDENTON MO
65020-1887
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5951
  • Fax: 573-346-3252
Mailing address:
  • Phone: 573-346-5951
  • Fax: 573-346-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02691
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: