1598946931 NPI number — ST. LOUIS EYE CARE SPECIALISTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598946931 NPI number — ST. LOUIS EYE CARE SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LOUIS EYE CARE SPECIALISTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598946931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 OLD BALLAS RD
Provider Second Line Business Mailing Address:
SUITE #220
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-7083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-997-3937
Provider Business Mailing Address Fax Number:
314-997-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 OLD BALLAS RD
Provider Second Line Business Practice Location Address:
SUITE #220
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-7083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-997-3937
Provider Business Practice Location Address Fax Number:
314-997-3911
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRUCKHOFF
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
314-997-3937

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  103579 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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