Provider Demographics
NPI:1275539173
Name:COMPLETE EYE CARE, INC.
Entity Type:Organization
Organization Name:COMPLETE EYE CARE, INC.
Other - Org Name:CLINICAL OPHTHALMOLOGY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TYCHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-395-9613
Mailing Address - Street 1:9890 CLAYTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-395-9613
Mailing Address - Fax:314-395-9621
Practice Address - Street 1:9890 CLAYTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-395-9613
Practice Address - Fax:314-395-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10876Medicare UPIN
MO990000936Medicare PIN
MO0921560001Medicare NSC