Organization
SPEC SHOPPE II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MARK FARNAN (CO-OWNER)
(660) 783-2870
Entity
Organization
Contact information
Practice address
301 N PARK ST, STANBERRY, MO 64489-1245
(660) 783-2870
Mailing address
301 N PARK ST, STANBERRY, MO 64489-1245
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
22104119
MO
Other
Enumeration date
01/06/2015
Last updated
01/06/2015
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