Provider Demographics
NPI:1225211477
Name:PEPOSE VISION INSTITUTE, PC
Entity Type:Organization
Organization Name:PEPOSE VISION INSTITUTE, PC
Other - Org Name:PRECISION OPTIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PEPOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:636-728-0111
Mailing Address - Street 1:1815 CLARKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5065
Mailing Address - Country:US
Mailing Address - Phone:636-728-0111
Mailing Address - Fax:636-728-0093
Practice Address - Street 1:1815 CLARKSON ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5065
Practice Address - Country:US
Practice Address - Phone:636-728-0111
Practice Address - Fax:636-728-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6204410001Medicare NSC