Individual
DR. THOMAS A DETTMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5962 HIGHWAY 54, OSAGE BEACH, MO 65065-3338
(573) 552-8569
(573) 348-2747
Mailing address
6436 RED BARN, OSAGE BEACH, MO 65065-3069
(573) 552-8569
(573) 348-2747
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03438
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T03438
LICENSE
MO
Enumeration date
09/14/2005
Last updated
08/17/2010
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