Provider Demographics
NPI:1063758548
Name:EYE CARE CHARITY OF MID-AMERICA
Entity type:Organization
Organization Name:EYE CARE CHARITY OF MID-AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:636-778-1022
Mailing Address - Street 1:732 GODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1100
Mailing Address - Country:US
Mailing Address - Phone:636-778-1022
Mailing Address - Fax:
Practice Address - Street 1:732 GODDARD AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1100
Practice Address - Country:US
Practice Address - Phone:636-778-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty