Provider Demographics
NPI:1770589855
Name:DELTERGO -WACHTER, MARGARET (OD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:DELTERGO -WACHTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:DEL TERGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:2404 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1222
Practice Address - Country:US
Practice Address - Phone:636-458-8787
Practice Address - Fax:636-405-0629
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO180031809OtherRAILROAD MEDICARE
MO316947712Medicaid
MOU17830Medicare UPIN
MO005006438Medicare PIN
MOMA5227055Medicare UPIN