Provider Demographics
NPI:1871223883
Name:ARP, MACY BREANNE (OD)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:BREANNE
Last Name:ARP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0106
Mailing Address - Country:US
Mailing Address - Phone:573-446-1600
Mailing Address - Fax:
Practice Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0106
Practice Address - Country:US
Practice Address - Phone:573-446-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist