Powell Optometry a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2187 Issued in MO

Legal business name

POWELL OPTOMETRY A PROFESSIONAL CORPORATION

Practice address

2320 S Main St
Maryville, MO 64468-3622

Phone

(660) 582-4022

Fax

(660) 582-4038

NPI assigned

Aug 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Haidon Powell, O.D.

Title

Owner

Phone

(660) 582-4022

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1447441050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644683622",
            "telephone_number": "660-582-4022",
            "fax_number": "660-582-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644683622",
            "telephone_number": "660-582-4022",
            "fax_number": "660-582-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWELL OPTOMETRY A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "HAIDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-582-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2187",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2002015841",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "33776015",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DE0846",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Peters, ATC, LAT
• Rachel L Petty
• Donna K Pile
• Holly Poppa, FNP
• Nicole M Poppa, HIS
• Isla Powell
• Jeffrey Haidon Powell, OD
• Harold Lee Poynter III, O. D.
• Jeremy Poynter
• Paul Richard Poynter, O. D.

• Optometrist in Maryville, MO
• Providers in Maryville, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.