Provider Demographics
NPI:1598712242
Name:HORNBY, CHARLES MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MATTHEW
Last Name:HORNBY
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 1:305 S KYLER ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2603
Mailing Address - Country:US
Mailing Address - Phone:417-236-1144
Mailing Address - Fax:417-236-1138
Practice Address - Street 1:885 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9367
Practice Address - Country:US
Practice Address - Phone:417-236-1144
Practice Address - Fax:417-236-1138
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027453152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT78434Medicare UPIN
MO000025572Medicare ID - Type Unspecified