Provider Demographics
NPI:1972738862
Name:EYE CARE VISION CENTER II INC ERKERS KIRKWOOD
Entity type:Organization
Organization Name:EYE CARE VISION CENTER II INC ERKERS KIRKWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUBANY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-966-8587
Mailing Address - Street 1:124 W JEFFERSON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4064
Mailing Address - Country:US
Mailing Address - Phone:314-966-8587
Mailing Address - Fax:314-966-0650
Practice Address - Street 1:124 W JEFFERSON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4064
Practice Address - Country:US
Practice Address - Phone:314-966-8587
Practice Address - Fax:314-966-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02593305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization