Provider Demographics
NPI:1184892549
Name:MINDY B. RENNARD O.D. LLC
Entity type:Organization
Organization Name:MINDY B. RENNARD O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-878-3027
Mailing Address - Street 1:753 CEDAR FIELD CT.
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5727
Mailing Address - Country:US
Mailing Address - Phone:314-878-3027
Mailing Address - Fax:
Practice Address - Street 1:100 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1123
Practice Address - Country:US
Practice Address - Phone:636-536-4609
Practice Address - Fax:636-536-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty