Provider Demographics
NPI:1528378437
Name:PALOMBI VISION CENTER PC
Entity Type:Organization
Organization Name:PALOMBI VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PALOMBI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-639-9422
Mailing Address - Street 1:1155 WENTZVILLE PKWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3476
Mailing Address - Country:US
Mailing Address - Phone:636-639-9422
Mailing Address - Fax:636-639-6713
Practice Address - Street 1:1155 WENTZVILLE PKWY
Practice Address - Street 2:SUITE 119
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3476
Practice Address - Country:US
Practice Address - Phone:636-639-9422
Practice Address - Fax:636-639-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02651261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care