Provider Demographics
NPI:1588754758
Name:SACHO, GREGORY R (OD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:SACHO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12386 TOPSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-628-9009
Mailing Address - Fax:
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2306
Practice Address - Country:US
Practice Address - Phone:618-281-4500
Practice Address - Fax:618-281-4595
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006642152W00000X
MOT02381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79307Medicare UPIN
MOMA1595035Medicare PIN
IL4099090001Medicare NSC
ILL83785Medicare PIN
IL574580Medicare ID - Type Unspecified