| |
2315 Dougherty Ferry Rd Ste 101, Saint Louis, MO 63122-3313 | |
(314) 822-3776 | |
(314) 822-6281 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 2315 Dougherty Ferry Rd Ste 101, Saint Louis, Missouri |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609823863 | NPI | - | NPPES |
23976 | Other | MO | BCBS |
240438606 | Medicaid | MO | |
CJ9636 | Other | MO | MEDICARE RAILROAD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2005020537 (Missouri) | Secondary |
207W00000X | Ophthalmology | 30117 (Missouri) | Primary |
Mailing Address | Practice Location Address |
---|---|
2315 Dougherty Ferry Rd Ste 101, Saint Louis, MO 63122-3313 Ph: (314) 822-3776 | 2315 Dougherty Ferry Rd Ste 101, Saint Louis, MO 63122-3313 Ph: (314) 822-3776 |