Individual
DR. ANTHONY PAUL DEWILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 APPLE VALLEY PKWY, BELTON, MO 64012-4725
(816) 331-9590
(816) 331-9591
Mailing address
101 APPLE VALLEY PKWY, BELTON, MO 64012-4725
(816) 331-9590
(816) 331-9591
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2007024168
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598067902
MEDICARE GROUP
MO
01
—
MA2901
PTAN
MO
Enumeration date
09/07/2007
Last updated
05/25/2011
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