Healthcare Provider Details

I. General information

NPI: 1942430764
Provider Name (Legal Business Name): JONATHAN TOVEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 S COCHISE DR
INDEPENDENCE MO
64055-6974
US

IV. Provider business mailing address

4801 S CLIFF AVE SUITE 100
INDEPENDENCE MO
64055-7015
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2015025683
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: