Organization
MICHAEL MONTGOMERY OD PC
Active
Other names
Family Eyecare Associates 43-1628740
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R MONTGOMERY O.D., P.C. (DOCTOR OF OPTOMETRY)
(417) 532-2562
Entity
Organization
Contact information
Practice address
279 E ELM, LEBANON, MO 65536
(417) 532-2562
Mailing address
PO BOX 248, 279 EAST ELM, LEBANON, MO 65536-0248
(417) 532-2562
(417) 592-2409
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2552
MO
207W00000X
Ophthalmology Physician
Primary
TO2552
MO
332H00000X
Eyewear Supplier
2552
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312368301
—
MO
Enumeration date
03/08/2007
Last updated
03/14/2011
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