Provider Demographics
NPI:1962501353
Name:BATEK, SHARON K (OD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:BATEK
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 1:405 COURT ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1724
Mailing Address - Country:US
Mailing Address - Phone:573-642-5995
Mailing Address - Fax:573-642-5995
Practice Address - Street 1:405 COURT ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1724
Practice Address - Country:US
Practice Address - Phone:573-642-5995
Practice Address - Fax:573-642-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU51995Medicare UPIN
4348310001Medicare NSC