Provider Demographics
NPI:1750629481
Name:DAVID L REMINGTON OD PC
Entity Type:Organization
Organization Name:DAVID L REMINGTON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-882-6456
Mailing Address - Street 1:1951 BOONE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1994
Mailing Address - Country:US
Mailing Address - Phone:660-882-6456
Mailing Address - Fax:
Practice Address - Street 1:1951 BOONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1994
Practice Address - Country:US
Practice Address - Phone:660-882-6456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02332332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4354Medicare PIN