| Organization Name: | ETTINGER OPTOMETRY, LLC |
| NPI Number: | 1003263096 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRA NATHAN ETTINGER (OPTOMETRIST) |
| Mailing Address: | 143 Replacement Ave Building 487 Fort Leonard Wood |
| State: | MO US |
| Postal Code: | 654739092 |
| Phone Number: | 5733294860 |
| Fax Number: | 5733294860 |
| NPI Enumeration Date: | 05/19/2016 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | T02543 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |