Provider Demographics
NPI:1932328994
Name:HART, JULIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:HART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:808 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2023
Mailing Address - Country:US
Mailing Address - Phone:417-255-2010
Mailing Address - Fax:417-255-2027
Practice Address - Street 1:808 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2023
Practice Address - Country:US
Practice Address - Phone:417-255-2010
Practice Address - Fax:417-255-2027
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003409B152W00000X
MO2006018277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1689845323OtherGROUP NPI
MO319913307Medicaid
MO1689845323OtherGROUP NPI