Provider Demographics
NPI:1306997226
Name:HAGE, DEBORAH ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:HAGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:TOKARCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 NW BARRY RD
Mailing Address - Street 2:C/O J C PENNEY OPTICAL
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-468-0137
Mailing Address - Fax:816-468-0137
Practice Address - Street 1:400 NW BARRY ROAD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:816-468-0137
Practice Address - Fax:816-468-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist