Individual
MICHELLE DERHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12990 MANCHESTER RD, SUITE 201, DES PERES, MO 63131-1860
(314) 909-0633
(314) 909-0391
Mailing address
12990 MANCHESTER RD, SUITE 201, DES PERES, MO 63131-1860
(314) 909-0633
(314) 909-0391
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2013025320
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013025320
OPTOMETRIC LICENSE
MO
Enumeration date
07/16/2013
Last updated
07/16/2013
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