MEDICARE: DR. DEBRA R RENNER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003068	IN
2	152W00000X	Optometrist	2008032353	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1013072966	OTHER	MO	INDIVIDUAL NPI
2	1962644732	OTHER	MO	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013072966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA R RENNER O.D.

Provider Business Mailing Address
First Line	:	1400 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1997
Country	:	US
Telephone Number	:	573-446-0331
Fax Number	:	573-446-6991

Provider Business Practice Location Address
First Line	:	1400 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1997
Country	:	US
Telephone Number	:	573-446-0331
Fax Number	:	573-446-6991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/17/2011

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