Individual
JOHN A GAZAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
138 S. MAIN, SUITE C, LAURIE, MO 65038
(573) 374-5222
(573) 374-7351
Mailing address
P.O. BOX 1185, LAURIE, MO 65038
(573) 374-5222
(573) 374-7351
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1520T
IA
152W00000X
Optometrist
Primary
2009002132
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057075
—
IA
01
—
05707
BLUE SHIELD
IA
Enumeration date
10/03/2006
Last updated
09/01/2010
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