Provider Demographics
NPI:1245421577
Name:KENT E. STUDER OD, PC
Entity Type:Organization
Organization Name:KENT E. STUDER OD, PC
Other - Org Name:EYECARE OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:STUDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-449-4356
Mailing Address - Street 1:401 LOCUST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4262
Mailing Address - Country:US
Mailing Address - Phone:573-449-4356
Mailing Address - Fax:573-442-0124
Practice Address - Street 1:401 LOCUST ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4262
Practice Address - Country:US
Practice Address - Phone:573-449-4356
Practice Address - Fax:573-442-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000091011Medicare PIN
MO1157630001Medicare NSC