Healthcare Provider Details

I. General information

NPI: 1700885860
Provider Name (Legal Business Name): DOUGLAS GERARD HERRIOTT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NW MCNARY CT
LEES SUMMIT MO
64086-4011
US

IV. Provider business mailing address

221 NW MCNARY CT
LEES SUMMIT MO
64086-4011
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-8900
  • Fax: 816-525-2042
Mailing address:
  • Phone: 816-524-8900
  • Fax: 816-525-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3842-35
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI5-0000006
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-02668
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1194-2
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3889
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1634
License Number StateNE
# 8
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13504640-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: