Healthcare Provider Details

I. General information

NPI: 1851744551
Provider Name (Legal Business Name): LORI DEJARNETT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N BELT HWY
SAINT JOSEPH MO
64506-2006
US

IV. Provider business mailing address

PO BOX 207158
DALLAS TX
75320-7158
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-0450
  • Fax: 816-364-0487
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8970T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2021014837
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: