Provider Demographics
NPI:1104832021
Name:WERNER, DAVID MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WERNER
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:600 N MAIN ST
Mailing Address - Street 2:GENE TAYLOR V.A. OUTPATIENT CLINIC
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1004
Mailing Address - Country:US
Mailing Address - Phone:417-466-0182
Mailing Address - Fax:417-466-0126
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:GENE TAYLOR V.A. OUTPATIENT CLINIC
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1004
Practice Address - Country:US
Practice Address - Phone:417-466-0182
Practice Address - Fax:417-466-0126
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU44310Medicare UPIN