Individual
MRS. REBECCA JANE LAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPT
Contact information
Practice address
2632 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 623-3448
(417) 623-3448
Mailing address
2632 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 623-3448
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
N/A
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320412703
—
MO
Enumeration date
06/09/2006
Last updated
02/18/2008
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