Healthcare Provider Details

I. General information

NPI: 1275710014
Provider Name (Legal Business Name): OBERMARK OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MAIN ST
WASHINGTON MO
63090-2154
US

IV. Provider business mailing address

222 W MAIN ST
WASHINGTON MO
63090-2154
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-7144
  • Fax: 636-239-6266
Mailing address:
  • Phone: 636-239-7144
  • Fax: 636-239-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA MITCHELL OBERMARK
Title or Position: OFFICER / MANAGER
Credential: RN, BSN, ABOC
Phone: 636-239-7144