Provider Demographics
NPI:1366037244
Name:GATEWAY LOW VISION LLC
Entity Type:Organization
Organization Name:GATEWAY LOW VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOGIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-328-9919
Mailing Address - Street 1:522 N NEW BALLAS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6820
Mailing Address - Country:US
Mailing Address - Phone:314-328-9919
Mailing Address - Fax:314-228-2104
Practice Address - Street 1:522 N NEW BALLAS RD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6820
Practice Address - Country:US
Practice Address - Phone:314-517-5893
Practice Address - Fax:314-312-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty