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General NPI Number Information
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NPI Number | 1427828110
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Entity Type | Organization
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Legal Business Name | DONIPHAN VISION IMPROVEMENT CLINIC, LLC
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 204 WASHINGTON ST
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City | DONIPHAN
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State | MO
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Zip | 63935-1763
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Country | US
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Telephone | 996-393-7573
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Fax |
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Provider Business Mailing Address
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Address Line | 204 WASHINGTON ST
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City | DONIPHAN
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State | MO
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Zip | 63935-1763
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Country | US
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Telephone | 996-393-7573
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JENNIFER HOWARD
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Credential | OD
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Telephone | 573-421-5986
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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 |
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License Number State |
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