Provider Demographics
NPI:1962868463
Name:THE KOETTING ASSOCIATES INC.
Entity type:Organization
Organization Name:THE KOETTING ASSOCIATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-863-0000
Mailing Address - Street 1:2511 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2308
Mailing Address - Country:US
Mailing Address - Phone:314-863-0000
Mailing Address - Fax:314-961-1041
Practice Address - Street 1:113 OLD STATE RD
Practice Address - Street 2:SUITE101
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63021-2042
Practice Address - Country:US
Practice Address - Phone:636-256-7800
Practice Address - Fax:636-394-1011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KOETTING ASSOCIATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty