Individual
DR. JEFFREY HAIDON POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2320 S MAIN ST, MARYVILLE, MO 64468-3622
(660) 582-4022
(660) 582-4038
Mailing address
2320 SOUTH MAIN ST., MARYVILLE, MO 64468
(660) 582-4022
(660) 582-4038
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3974310001
CIGNA MEDICARE
MO
Enumeration date
01/26/2006
Last updated
10/11/2007
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