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NPI Code Detail

MEDICARE: DR. THERESA OSBORNE OD

MEDICARE: DR. THERESA OSBORNE OD
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
1152W00000XOptometrist046011797IL
2152W00000XOptometrist2021042331MO

General Provider Information

NPI Number : 1720741358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA OSBORNE OD
Provider Business Mailing Address
First Line : 1800 COMMUNITY
Second Line :
City : CLINTON
State : MO
Zip : 64735-8804
Country : US
Telephone Number : 844-853-8937
Fax Number : 660-885-3690
Provider Business Practice Location Address
First Line : 1275 N TRUMAN BLVD
Second Line :
City : FESTUS
State : MO
Zip : 63028-1176
Country : US
Telephone Number : 844-853-8937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2021
Last Update Date : 12/11/2025

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Directions to “ DR. THERESA OSBORNE OD” Practice Location

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