Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1859 | NC |
Y | 152W00000X | Optometrist | 2006001515 | MO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2006001515 | MO |
NPI | 1124043724 |
---|---|
Provider Name | Dr. Jamal James Fox |
First Address | Maryland Heights, MO 63043-2207 |
Second Address | Florissant, MO 63034-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U93921 | (02) | MO |