Provider Demographics
NPI:1508546573
Name:EYE SEE VISION CENTER, LLC
Entity Type:Organization
Organization Name:EYE SEE VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-651-3883
Mailing Address - Street 1:4737 E SWALLER RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1219
Mailing Address - Country:US
Mailing Address - Phone:314-651-3883
Mailing Address - Fax:
Practice Address - Street 1:9549 WATSON ROAD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63126
Practice Address - Country:US
Practice Address - Phone:314-651-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty