Individual
BRETT D KOONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
323 E HIGHWAY 54, SUITE 104, CAMDENTON, MO 65020-9599
(573) 346-7899
(573) 346-7744
Mailing address
PO BOX 1314, CAMDENTON, MO 65020-1314
(573) 346-7899
(573) 346-7744
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2007031193
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007031193
STATE LICENSE
MO
Enumeration date
10/25/2007
Last updated
10/25/2007
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