Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2004018570 | MO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2004018570 | MO |
NPI | 1346356086 |
---|---|
Provider Name | Dr. Julie Lynn Dekinder |
First Address | Saint Louis, MO 63121-4400 |
Second Address | Saint Louis, MO 63121-4617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V03439 | (02) |