Provider Demographics
NPI:1497019939
Name:TLC VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TLC VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARICE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-534-2234
Mailing Address - Street 1:16305 SWINGLEY RIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1777
Mailing Address - Country:US
Mailing Address - Phone:636-534-2300
Mailing Address - Fax:636-489-0206
Practice Address - Street 1:7930 JONES BRANCH DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3388
Practice Address - Country:US
Practice Address - Phone:703-761-4999
Practice Address - Fax:703-761-4960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC VISION CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty