Individual
DR. MICHAEL R MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
279 E ELM ST, LEBANON, MO 65536-3610
(417) 532-2562
(417) 532-2409
Mailing address
279 E ELM ST, LEBANON, MO 65536-3610
(417) 532-2562
(417) 532-2409
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02552
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117102
BCBC-LEBABON LOCATION
—
01
—
117105
BCBS
—
01
—
12603
SPECTERA-LEBANON LOCATION
—
05
—
312368319
—
MO
Enumeration date
12/05/2005
Last updated
11/27/2012
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