Provider Demographics
NPI:1083643753
Name:PREWITT, DARCI LEA HUNTER (OD)
Entity Type:Individual
Prefix:DR
First Name:DARCI
Middle Name:LEA HUNTER
Last Name:PREWITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:LEA
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:123A S.COUNTY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-416-7588
Mailing Address - Fax:314-416-9368
Practice Address - Street 1:LENSCRAFTERS
Practice Address - Street 2:122A S COUNTY CENTER WAY
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1092
Practice Address - Country:US
Practice Address - Phone:314-416-7588
Practice Address - Fax:314-416-9368
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009909152W00000X
MOT03265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083643753OtherNPI
MO000025571OtherMEDICARE ID TYPE UNSPECIFIED
IL255715282OtherMEDICARE IDENTIFIER
MO000025571Medicare ID - Type UnspecifiedMEDICARE SERVICES /PART B
MO000025571OtherMEDICARE ID TYPE UNSPECIFIED