Provider Demographics
NPI:1992442214
Name:FOUR CIRCLES VISION THERAPY
Entity type:Organization
Organization Name:FOUR CIRCLES VISION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-294-3197
Mailing Address - Street 1:3449 PHEASANT MEADOW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7364
Mailing Address - Country:US
Mailing Address - Phone:636-294-3197
Mailing Address - Fax:855-812-9227
Practice Address - Street 1:3449 PHEASANT MEADOW DR STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7364
Practice Address - Country:US
Practice Address - Phone:636-294-3197
Practice Address - Fax:855-812-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center