Provider Demographics
NPI:1770769499
Name:JUNK, THOMAS G (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:JUNK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9507
Mailing Address - Country:US
Mailing Address - Phone:573-335-2787
Mailing Address - Fax:573-335-3856
Practice Address - Street 1:3439 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9507
Practice Address - Country:US
Practice Address - Phone:573-335-2787
Practice Address - Fax:573-335-3856
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU28510Medicare UPIN