Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 18003068 | IN |
Y | 152W00000X | Optometrist | 2008032353 | MO |
NPI | 1013072966 |
---|---|
Provider Name | Dr. Debra R Renner |
First Address | Columbia, MO 65203-1997 |
Second Address | Columbia, MO 65203-1997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 17/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013072966 | (05) | MO |
1013072966 | INDIVIDUAL NPI (01) | MO |
1962644732 | GROUP NPI (01) | MO |
U81075 | (02) | IN |
U81075 | (02) | MO |