Provider Demographics
NPI:1285818542
Name:JERMIK SYSTEMS, LTD
Entity Type:Organization
Organization Name:JERMIK SYSTEMS, LTD
Other - Org Name:KURSAR EYECARE, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KURSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-291-7717
Mailing Address - Street 1:3454 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2533
Mailing Address - Country:US
Mailing Address - Phone:314-291-7717
Mailing Address - Fax:314-291-7372
Practice Address - Street 1:3454 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2533
Practice Address - Country:US
Practice Address - Phone:314-291-7717
Practice Address - Fax:314-291-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018118152W00000X
MO2005020537152W00000X
MO30117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240438606Medicaid
MOCJ9636OtherMEDICARE RAILROAD
MO23976OtherBCBS
MOCJ9636OtherMEDICARE RAILROAD
MO000013643Medicare PIN