Provider Demographics
NPI:1871867408
Name:HUNT & NOSACKA OPTOMETRIC GROUP P.C.
Entity Type:Organization
Organization Name:HUNT & NOSACKA OPTOMETRIC GROUP P.C.
Other - Org Name:SEMO VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-714-2075
Mailing Address - Street 1:1122 N DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-1342
Mailing Address - Country:US
Mailing Address - Phone:573-276-3239
Mailing Address - Fax:
Practice Address - Street 1:1122 N DOUGLASS ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1342
Practice Address - Country:US
Practice Address - Phone:573-276-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty