| |
3454 Mckelvey Rd, Bridgeton, MO 63044-2533 | |
(314) 291-7717 | |
(314) 291-7372 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 3454 Mckelvey Rd, Bridgeton, Missouri |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1285818542 | NPI | - | NPPES |
240438606 | Medicaid | MO | |
CJ9636 | Other | MO | MEDICARE RAILROAD |
23976 | Other | MO | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2001018118 (Missouri) | Secondary |
152W00000X | Optometrist | 2005020537 (Missouri) | Secondary |
207W00000X | Ophthalmology | 30117 (Missouri) | Primary |
Mailing Address | Practice Location Address |
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3454 Mckelvey Rd, Bridgeton, MO 63044-2533 Ph: (314) 291-7717 | 3454 Mckelvey Rd, Bridgeton, MO 63044-2533 Ph: (314) 291-7717 |