Provider Demographics
NPI:1083288963
Name:EYES ON STE GENEVIEVE LLC
Entity type:Organization
Organization Name:EYES ON STE GENEVIEVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-803-8951
Mailing Address - Street 1:1227 PAULANNA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4087
Mailing Address - Country:US
Mailing Address - Phone:314-803-8951
Mailing Address - Fax:
Practice Address - Street 1:466 MARKET ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1520
Practice Address - Country:US
Practice Address - Phone:573-883-2774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty