Provider Demographics
NPI:1588742027
Name:VANCARDO, JULIE C (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:C
Last Name:VANCARDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 GRANDVIEW FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-0045
Mailing Address - Country:US
Mailing Address - Phone:636-530-0202
Mailing Address - Fax:
Practice Address - Street 1:92 CHESTERFIELD MALL
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4808
Practice Address - Country:US
Practice Address - Phone:636-530-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU91849Medicare UPIN