Provider Demographics
NPI:1245411776
Name:ERNST EYE HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:ERNST EYE HEALTH ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-456-2020
Mailing Address - Street 1:277 W VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1067
Mailing Address - Country:US
Mailing Address - Phone:636-456-2020
Mailing Address - Fax:
Practice Address - Street 1:277 W VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1067
Practice Address - Country:US
Practice Address - Phone:636-456-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02923152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1311960001Medicare NSC