Individual
DR. DEBRA R RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18003068
IN
152W00000X
Optometrist
Primary
2008032353
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013072966
INDIVIDUAL NPI
MO
05
—
1013072966
—
MO
01
—
1962644732
GROUP NPI
MO
Enumeration date
12/22/2006
Last updated
08/17/2011
Update your record
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