Individual
DR. MICHAEL R. PENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3061 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-8658
(573) 785-1442
(573) 776-6024
Mailing address
3061 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-8658
(573) 785-1442
(573) 776-6024
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02754
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487752044
—
MO
Enumeration date
09/20/2006
Last updated
03/10/2014
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