Provider Demographics
NPI:1528227113
Name:EYE PHYSICIANS OF ST LOUIS
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF ST LOUIS
Other - Org Name:PERNOUD EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLESHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-351-0101
Mailing Address - Street 1:6680 CHIPPEWA ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2537
Mailing Address - Country:US
Mailing Address - Phone:314-351-0101
Mailing Address - Fax:314-351-4697
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-351-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010516Medicare PIN