Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2014001815 | MO |
N | 152W00000X | Optometrist | 774 | MS |
NPI | 1013105022 |
---|---|
Provider Name | Eli B Lemonier |
First Address | Springfield, MO 65809-2029 |
Second Address | Springfield, MO 65806-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 22/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12035182 | CAQH (01) |