MEDICARE: R.G.PALMER O.D,P.C.

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	TO2059	MO

General Provider Information

NPI Number	:	1366697781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.G.PALMER O.D,P.C.

Provider Business Mailing Address
First Line	:	323 MONROE ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	573-634-8500

Provider Business Practice Location Address
First Line	:	323 MONROE ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3105
Country	:	US
Telephone Number	:	573-635-1313
Fax Number	:	573-634-8500

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	RUSSELL G. PALMER
Credential	:	OD
Telephone Number	:	573-635-1313

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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