Provider Demographics
NPI:1497441265
Name:SUCCESS VISION EYECARE OF MAPLEWOOD LLC
Entity Type:Organization
Organization Name:SUCCESS VISION EYECARE OF MAPLEWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-800-2020
Mailing Address - Street 1:5312 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6110
Mailing Address - Country:US
Mailing Address - Phone:918-800-2020
Mailing Address - Fax:877-464-4002
Practice Address - Street 1:2021 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-1003
Practice Address - Country:US
Practice Address - Phone:918-800-2020
Practice Address - Fax:877-464-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty