Healthcare Provider Details

I. General information

NPI: 1841278462
Provider Name (Legal Business Name): ROBERT M. PALMER, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S STURGEON ST SUITE A
MONTGOMERY CITY MO
63361-2558
US

IV. Provider business mailing address

215 S STURGEON ST SUITE A
MONTGOMERY CITY MO
63361-2558
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-3877
  • Fax: 573-564-3515
Mailing address:
  • Phone: 573-564-3877
  • Fax: 573-564-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02346
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT M PALMER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 573-564-3877