Provider Demographics
NPI:1043835580
Name:MCCOY, MATTHEW K (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:MCCOY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9979 WINGHAVEN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3628
Mailing Address - Country:US
Mailing Address - Phone:636-685-8555
Mailing Address - Fax:636-695-8555
Practice Address - Street 1:3821 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6416
Practice Address - Country:US
Practice Address - Phone:636-928-1111
Practice Address - Fax:636-928-1111
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020015826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist