Individual
DR. KATHRYN A. MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
812 N ONE MILE RD, DEXTER, MO 63841-1034
(573) 614-5393
(573) 614-5639
Mailing address
812 N ONE MILE RD, DEXTER, MO 63841-1034
(573) 614-5393
(573) 614-5639
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2009016930
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124275235
—
MO
01
—
MA1184
MEDICARE PTAN
—
Enumeration date
08/20/2008
Last updated
09/18/2012
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