Provider Demographics
NPI:1417315706
Name:OM VISION SERVICES INC,
Entity type:Organization
Organization Name:OM VISION SERVICES INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILBER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:214-912-7272
Mailing Address - Street 1:13329 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1710
Mailing Address - Country:US
Mailing Address - Phone:314-965-4435
Mailing Address - Fax:
Practice Address - Street 1:13329 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1710
Practice Address - Country:US
Practice Address - Phone:314-965-4435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4119Medicare UPIN