John T Gudmundson – Optometrist in Des Peres, MO

Key facts

NPI: 1275835274
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: T02992 (MO)
Legal business name: JOHN T GUDMUNDSON
Practice address: 13455 Manchester Rd
Des Peres, MO 63131-1711
Phone: (314) 822-4423
Fax: (314) 822-5541
NPI assigned: Nov 23, 2010
Organization subpart: No

Authorized official

Name: Dr. John T Gudmundson, OD NPI 1427196914
Title: Doctor
Phone: (636) 390-3999

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

John T. Gudmundson, O.D. Optometrist · Des Peres, MO · NPI 1427196914

NPD (past) Authorized official OPTOMETRIST

National Provider Directory

Locations

13455 Manchester Rd
Saint Louis, MO 63131
Phone (314) 822-2006

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X	T02992	MO	Yes

Addresses

Primary practice location

13455 Manchester Rd
Des Peres, MO 63131-1711

Mailing address

901 E 3Rd St
Washington, MO 63090-3010
Phone (636) 390-3999

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 23, 2010.

{
    "created_epoch": "1290470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290470400000",
    "number": "1275835274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 3RD ST",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903010",
            "telephone_number": "636-390-3999",
            "fax_number": "636-390-3959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13455 MANCHESTER RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311711",
            "telephone_number": "314-822-4423",
            "fax_number": "314-822-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T GUDMUNDSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-23",
        "last_updated": "2010-11-23",
        "status": "A",
        "authorized_official_last_name": "GUDMUNDSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "636-390-3999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Peres, MO

All providers in Des Peres, MO · Optometrist in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.