Provider Demographics
NPI:1043233653
Name:HUNTER, DENNIS LEON (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEON
Last Name:HUNTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1929
Mailing Address - Country:US
Mailing Address - Phone:660-886-5517
Mailing Address - Fax:660-886-5074
Practice Address - Street 1:365 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1929
Practice Address - Country:US
Practice Address - Phone:660-886-5517
Practice Address - Fax:660-886-5074
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310267000Medicaid
MOA601992Medicare PIN
MO1309230001Medicare NSC
MO007023001Medicare PIN
MOT42496Medicare UPIN