Provider Demographics
NPI:1114066776
Name:DOELL, DAVIDSON & ASSOCIATES
Entity Type:Organization
Organization Name:DOELL, DAVIDSON & ASSOCIATES
Other - Org Name:CENTER FOR VISION & LEARNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-9100
Mailing Address - Street 1:12401 OLIVE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5448
Mailing Address - Country:US
Mailing Address - Phone:314-628-9100
Mailing Address - Fax:314-628-9191
Practice Address - Street 1:12401 OLIVE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5448
Practice Address - Country:US
Practice Address - Phone:314-628-9100
Practice Address - Fax:314-628-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV07439Medicare UPIN
MOT42561Medicare UPIN
MOU80680Medicare UPIN