Provider Demographics
NPI:1205961539
Name:POYNTER, HAROLD LEE III (O D)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LEE
Last Name:POYNTER
Suffix:III
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2444
Mailing Address - Country:US
Mailing Address - Phone:660-582-5222
Mailing Address - Fax:660-582-6558
Practice Address - Street 1:503 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2444
Practice Address - Country:US
Practice Address - Phone:660-582-5222
Practice Address - Fax:660-582-6558
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO17316019OtherBLUE CROSS BLUE SHIELD
MO17316019OtherBLUE CROSS BLUE SHIELD
MO4120711AMedicare ID - Type Unspecified