Healthcare Provider Details

I. General information

NPI: 1932328994
Provider Name (Legal Business Name): JULIE A HART O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE A FERGUSON O.D.

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N KENTUCKY AVE
WEST PLAINS MO
65775-2023
US

IV. Provider business mailing address

808 N KENTUCKY AVE
WEST PLAINS MO
65775-2023
US

V. Phone/Fax

Practice location:
  • Phone: 417-255-2010
  • Fax: 417-255-2027
Mailing address:
  • Phone: 417-255-2010
  • Fax: 417-255-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003409B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2006018277
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: