Provider Demographics
NPI:1043313588
Name:DOCTORS EYE CLINIC, INC
Entity Type:Organization
Organization Name:DOCTORS EYE CLINIC, INC
Other - Org Name:DES PERES EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-6137
Mailing Address - Street 1:12990 MANCHESTER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1804
Mailing Address - Country:US
Mailing Address - Phone:314-432-6137
Mailing Address - Fax:314-432-1237
Practice Address - Street 1:12990 MANCHESTER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1804
Practice Address - Country:US
Practice Address - Phone:314-432-6137
Practice Address - Fax:314-432-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0404790001Medicare NSC
MO990000015Medicare PIN