Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | T02237 | MO |
NPI | 1013096452 |
---|---|
Provider Name | Dr. Paul Richard Poynter |
First Address | Maryville, MO 64468-2444 |
Second Address | Maryville, MO 64468-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42519 | (02) | MO |