Kevin Daugherty, OD
Individual provider Active NPI Optometrist · O'Fallon, MO
NPI 1548150360 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1548150360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2025023537 (MO)
- Practice address
- 1307 State Hwy K
O'Fallon, MO 63366 - Phone
- (636) 980-2721
- NPI assigned
- Jul 3, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025023537 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2025023537 | MO | Yes |
Addresses
Primary practice location
1307 State Hwy K
O'Fallon, MO 63366
Mailing address
11157 E Maywood CT
Effingham, IL 62401-7429
Phone (217) 821-0920
Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2025. 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.