Healthcare Provider Details

I. General information

NPI: 1306739974
Provider Name (Legal Business Name): COLE SPADY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19040 E VALLEY VIEW PKWY
INDEPENDENCE MO
64055-7004
US

IV. Provider business mailing address

19040 E VALLEY VIEW PKWY
INDEPENDENCE MO
64055-7004
US

V. Phone/Fax

Practice location:
  • Phone: 816-200-2006
  • Fax:
Mailing address:
  • Phone: 816-200-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2025018547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: