Individual
WILLIAM R CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1000 W JACKSON ST, OZARK, MO 65721-9163
(417) 581-5581
(417) 581-5511
Mailing address
1000 W JACKSON ST, OZARK, MO 65721-9163
(417) 581-5581
(417) 581-5511
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2288
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310415237
—
MO
05
—
310415245
—
MO
01
—
4917230002
DMERC REGION D
MO
Enumeration date
11/10/2006
Last updated
04/30/2012
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