Kenneth Charles Detring O.D.

NPI 1093797052 - Optometrist - 152W00000X

NPI Details
NPI 1093797052
Gender Male
Enumeration Date 11/16/2005
Last Updated 02/28/2008
Entity Type Individual
Active Over 11 years ago
Practice Location
1014 E JACKSON BLVD
JACKSON MO, 63755-2436, US
Phone (573) 243-2020
Fax (573) 243-6684
Business Location
PO BOX 510
JACKSON MO, 63755-0510, US
Phone (573) 243-2020
Fax (573) 243-6684
Toxanomy
Taxonomy Code 152W00000X
License State Missouri
License Number TO2426
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According to our database, Kenneth Charles Detring O.D. NPI is 1093797052, taxonomy code is 152W00000X and license number is TO2426, license state is located at Missouri. Kenneth Charles Detring O.D. physically located at 1014 E Jackson Blvd, Jackson MO, 63755-2436. NPI Number Kenneth Charles Detring O.D. has the Individual type.

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1093797052 NPI number is provided on an as is basis without warranty of any kind. 1093797052 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Charles Detring O.D. are for informational purposes only.