=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457809485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY NICOLE CANNADAY O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2016
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 S MOUNT AUBURN RD
-----------------------------------------------------
City | CAPE GIRARDEAU
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63703-6387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-686-4151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 WESTMOUNT DR
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63640-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-756-2020
-----------------------------------------------------
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 | 2018039897
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3335
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------