Provider Demographics
NPI:1124069208
Name:JARVIS, DEVON PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:PAUL
Last Name:JARVIS
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 1:302 PROCTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9144
Mailing Address - Country:US
Mailing Address - Phone:417-742-2733
Mailing Address - Fax:417-742-2237
Practice Address - Street 1:302 PROCTER RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9144
Practice Address - Country:US
Practice Address - Phone:417-742-2733
Practice Address - Fax:417-742-2237
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317178408Medicaid
MO258704770Medicare PIN
MO5499110001Medicare NSC