Individual
VERNON GARY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1211 HAUCK DR, ROLLA, MO 65401-4900
(573) 364-6300
(573) 341-5058
Mailing address
PO BOX 490, ROLLA, MO 65402-0490
(573) 364-6300
(573) 341-5058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02294
MO
Other
Enumeration date
12/14/2005
Last updated
01/08/2008
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