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General NPI Number Information
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NPI Number | 1164413415
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Entity Type | Individual
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Provider Name | GARY WAYNE DELANCEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 113 OLD STATE RD SUITE 101
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City | ELLISVILLE
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State | MO
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Zip | 63021-2042
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Country | US
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Telephone | 636-256-7800
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Fax | 636-394-1011
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Provider Business Mailing Address
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Address Line | 113 OLD STATE RD SUITE 101
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City | ELLISVILLE
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State | MO
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Zip | 63021-2042
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Country | US
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Telephone | 636-256-7800
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Fax | 636-394-1011
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T02255
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | T02255
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License Number State | MO
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