Provider Demographics
NPI:1992939391
Name:DAVID REMINGTON
Entity type:Organization
Organization Name:DAVID REMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-882-6456
Mailing Address - Street 1:1951 BOONE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1994
Mailing Address - Country:US
Mailing Address - Phone:660-882-6456
Mailing Address - Fax:660-882-8088
Practice Address - Street 1:1951 BOONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1994
Practice Address - Country:US
Practice Address - Phone:660-882-6456
Practice Address - Fax:660-882-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0590260001Medicare NSC