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Individual

DEAMBRA LEA BOUCHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
13900 E US HIGHWAY 40 STE A, INDEPENDENCE, MO 64055-5877
(816) 478-0500
Mailing address
1644 NW GARRETT, BLUE SPRINGS, MO 64015
(316) 641-4219

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
1712
KS
152W00000X
Optometrist
Primary
2006016870
MO

Other

Enumeration date
10/16/2006
Last updated
07/08/2007
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