Provider Demographics
NPI:1598946931
Name:ST. LOUIS EYE CARE SPECIALISTS, LLC
Entity type:Organization
Organization Name:ST. LOUIS EYE CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUCKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:COA
Authorized Official - Phone:314-997-3937
Mailing Address - Street 1:675 OLD BALLAS RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7083
Mailing Address - Country:US
Mailing Address - Phone:314-997-3937
Mailing Address - Fax:314-997-3911
Practice Address - Street 1:675 OLD BALLAS RD
Practice Address - Street 2:SUITE #220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7083
Practice Address - Country:US
Practice Address - Phone:314-997-3937
Practice Address - Fax:314-997-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103579207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013646Medicare PIN
MOG52911Medicare UPIN