Organization
POWELL OPTOMETRY A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY HAIDON POWELL O.D. (OWNER)
(660) 582-4022
Entity
Organization
Contact information
Practice address
2320 S MAIN ST, MARYVILLE, MO 64468-3622
(660) 582-4022
(660) 582-4038
Mailing address
2320 S MAIN ST, MARYVILLE, MO 64468-3622
(660) 582-4022
(660) 582-4038
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2002015841
MO
152W00000X
Optometrist
Primary
TO2187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33776015
BLUE CROSS BLUE SHIELD
MO
01
—
DE0846
RAILROAD MEDICARE
MO
Enumeration date
08/08/2007
Last updated
12/05/2014
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