Provider Demographics
NPI:1548666076
Name:HARGUS, SAMUEL R II (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:HARGUS
Suffix:II
Gender:M
Credentials:OD
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Mailing Address - Street 1:15933 CLAYTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:544 CONESTOGA PKWY STE 17
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-5677
Practice Address - Country:US
Practice Address - Phone:502-955-2020
Practice Address - Fax:502-736-4488
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2025-08-18
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Provider Licenses
StateLicense IDTaxonomies
IN18003877A152W00000X
KY1972DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1548666076Medicare NSC