Provider Demographics
NPI:1396334488
Name:JACOB PIEPER O.D. LLC
Entity type:Organization
Organization Name:JACOB PIEPER O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:PIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-567-1856
Mailing Address - Street 1:1715 DEER TRACKS TRL STE 130
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1854
Mailing Address - Country:US
Mailing Address - Phone:314-567-1856
Mailing Address - Fax:
Practice Address - Street 1:1715 DEER TRACKS TRL STE 130
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1854
Practice Address - Country:US
Practice Address - Phone:314-567-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACOB PIEPER O.D. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty