Provider Demographics
NPI:1417049610
Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Entity Type:Organization
Organization Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Other - Org Name:EAST ST. LOUIS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:VINITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-516-6532
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:PATIENT CARE CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-5131
Mailing Address - Fax:314-516-5507
Practice Address - Street 1:601 JAMES R. THOMPSON BLVD
Practice Address - Street 2:BUILDING D, STE 2030
Practice Address - City:EAST ST. LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-1129
Practice Address - Country:US
Practice Address - Phone:618-482-8355
Practice Address - Fax:618-482-8360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CURATORS OF THE UNIVERSITY OF MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90-0294049OtherSUB-TIN
MO90-0294049OtherSUB-TIN