Individual
DR. DELTON L FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
111 N MAIN ST, NEVADA, MO 64772-2330
(417) 667-3076
(417) 667-8690
Mailing address
111 N MAIN ST, NEVADA, MO 64772-2330
(417) 667-3076
(417) 667-8690
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02263
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310041900
—
MO
Enumeration date
02/23/2007
Last updated
07/09/2007
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