Individual
DR. ORAL EDWARD BASS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2003028770
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015702
PTAN
MO
01
—
1013037365
INDIVIDUAL NPI
MO
05
—
1487825535
—
MO
Enumeration date
03/30/2007
Last updated
09/19/2013
Update your record
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