Provider Demographics
NPI:1508041088
Name:CATARACT & GLAUCOMA EYE CENTER OF ST. LOUIS, LTD.
Entity Type:Organization
Organization Name:CATARACT & GLAUCOMA EYE CENTER OF ST. LOUIS, LTD.
Other - Org Name:BECKER SPECS M.D.OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-352-5500
Mailing Address - Street 1:7220 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4404
Mailing Address - Country:US
Mailing Address - Phone:314-352-5500
Mailing Address - Fax:314-352-5500
Practice Address - Street 1:7220 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4404
Practice Address - Country:US
Practice Address - Phone:314-352-5500
Practice Address - Fax:314-352-5500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATARACT & GLAUCOMA EYE CENTER OF ST. LOUIS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0758290001OtherMEDICARE PROVIDER NUMBER