Provider Demographics
NPI:1598158529
Name:WILLIAM ODNEAL, O.D.
Entity type:Organization
Organization Name:WILLIAM ODNEAL, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ODNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-883-2774
Mailing Address - Street 1:466 MARKET ST
Mailing Address - Street 2:PO BOX 463
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1520
Mailing Address - Country:US
Mailing Address - Phone:573-883-2774
Mailing Address - Fax:573-883-9087
Practice Address - Street 1:466 MARKET ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1520
Practice Address - Country:US
Practice Address - Phone:573-883-2774
Practice Address - Fax:573-883-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310040316Medicaid
MOT42598Medicare UPIN
MO000006657Medicare PIN