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General NPI Number Information
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NPI Number | 1396939260
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Entity Type | Organization
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Legal Business Name | M.T. ALDRICH, OD, OPTOMETRY, PC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 1427 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2459
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Country | US
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Telephone | 816-279-2339
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Fax | 816-279-0110
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Provider Business Mailing Address
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Address Line | 1427 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2459
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Country | US
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Telephone | 816-279-2339
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Fax | 816-279-0110
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MAX T ALDRICH
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Credential | OD
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Telephone | 816-279-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | T02103
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License Number State | MO
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