Basic Information
| Provider Information | |||||||||
| NPI: | 1760450696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONOPIK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629818 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 WINDING WOODS CTR | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633664170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362815367 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2005019551 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 282286 | 01 | HEALTHLINK | OTHER | 317344810 | 05 | MO | MEDICAID | 269620 | 01 | GROUP HEALTH PLAN | OTHER | 60266 | 01 | MO | HEALTHCARE USA | OTHER | P00403021 | 01 | MO | RR MEDICARE | OTHER | 317344802 | 05 | MO | MEDICAID | MO9551 | 01 | EYEMED | OTHER |