Provider Demographics
NPI:1770576522
Name:STUDER, KENT E (O D)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:E
Last Name:STUDER
Suffix:
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 1:401 LOCUST ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4262
Mailing Address - Country:US
Mailing Address - Phone:573-449-4356
Mailing Address - Fax:573-442-0124
Practice Address - Street 1:401 LOCUST ST
Practice Address - Street 2:STE. 200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4262
Practice Address - Country:US
Practice Address - Phone:573-449-4356
Practice Address - Fax:573-442-0124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO91011Medicare ID - Type Unspecified
MOU54196Medicare UPIN