Individual
DR. LISA M NUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6000 N OAK TRFY STE 101, GLADSTONE, MO 64118-5176
(816) 454-1030
Mailing address
6000 N OAK TRFY STE 101, GLADSTONE, MO 64118-5176
(816) 454-1030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2002014342
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30976011
BLUE CROSS
MO
05
—
315972109
—
MO
01
—
410039208
RAILROAD MEDICARE
MO
01
—
431447951
TAX ID
MO
Enumeration date
02/07/2007
Last updated
10/06/2015
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