Provider Demographics
NPI:1588786750
Name:THE LOW VISION CENTER OF ST LOUIS INC
Entity type:Organization
Organization Name:THE LOW VISION CENTER OF ST LOUIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-821-1140
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:SUITE 2P
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-821-1140
Mailing Address - Fax:314-821-8324
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:SUITE 2P
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-821-1140
Practice Address - Fax:314-821-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2005152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108637OtherHEALTHLINK
MO22-02036OtherUNITED HEALTHCARE
MOMO 92005OtherVISION BENEFITS OF AMERIC
MO32395OtherBLUE CHOICE
MO33933Medicaid
MO262003OtherNATIONAL VISION ADMINISTR
MO400681OtherADVANTRA
MO16601OtherSPECTERA
MO32395OtherBLUE CROSS BLUE SHIELD
MO33933Medicaid
MO108637OtherHEALTHLINK
MO33933Medicaid