Provider Demographics
NPI:1538752811
Name:GATEWAY LOW VISION, LLC
Entity type:Organization
Organization Name:GATEWAY LOW VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-376-6445
Mailing Address - Street 1:8031 GANNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3710
Mailing Address - Country:US
Mailing Address - Phone:833-376-6445
Mailing Address - Fax:314-312-6984
Practice Address - Street 1:2821 N BALLAS ROAD
Practice Address - Street 2:SUITE C-11 LV
Practice Address - City:TOWN & COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:833-376-6445
Practice Address - Fax:314-312-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty