Provider Demographics
NPI:1013105022
Name:LEMONIER, ELI B (OD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:B
Last Name:LEMONIER
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 1:1724 W KEARNEY ST STE 116
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-1692
Mailing Address - Country:US
Mailing Address - Phone:417-865-4448
Mailing Address - Fax:417-862-8704
Practice Address - Street 1:1724 W KEARNEY ST STE 116
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1692
Practice Address - Country:US
Practice Address - Phone:417-865-4448
Practice Address - Fax:417-862-8704
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014001815152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12035182OtherCAQH