Provider Demographics
NPI:1770535965
Name:ALTENBERND, JAMES J (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:ALTENBERND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3549 YAEGER CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2369
Mailing Address - Country:US
Mailing Address - Phone:314-487-8651
Mailing Address - Fax:
Practice Address - Street 1:4512 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1614
Practice Address - Country:US
Practice Address - Phone:314-845-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO2917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist