Provider Demographics
NPI:1669821914
Name:KAY, LAURA (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MEDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-0774
Mailing Address - Country:US
Mailing Address - Phone:417-869-3937
Mailing Address - Fax:417-869-0281
Practice Address - Street 1:640 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1016
Practice Address - Country:US
Practice Address - Phone:417-869-3937
Practice Address - Fax:417-869-0281
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicaid
ARPENDINGMedicaid