Healthcare Provider Details

I. General information

NPI: 1720741358
Provider Name (Legal Business Name): THERESA OSBORNE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESS OSBORNE OD

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 N TRUMAN BLVD
FESTUS MO
63028-1176
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 844-853-8937
  • Fax: 660-885-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011797
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2021042331
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: