Provider Demographics
NPI:1659340958
Name:HUNTRESS, JAMES GREGORY
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:HUNTRESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 4TH ST
Mailing Address - Street 2:P.O. BOX 460
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2314
Mailing Address - Country:US
Mailing Address - Phone:417-235-2020
Mailing Address - Fax:
Practice Address - Street 1:215 4TH ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2314
Practice Address - Country:US
Practice Address - Phone:417-235-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312853807Medicaid
MOMA2116001OtherMEDICARE
MOMA2116001OtherMEDICARE
MO6382420001Medicare NSC
MO002007219Medicare ID - Type Unspecified