=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386349470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYDNEY MASTERS OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2023
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5202 FARAON ST
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-233-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4002 STACEY WAY CT
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64505-3219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2335DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------