Provider Demographics
NPI:1548386758
Name:IVERSON-TOMASINO EYECARE INC
Entity Type:Organization
Organization Name:IVERSON-TOMASINO EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMASINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-272-1444
Mailing Address - Street 1:302 E PITMAN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2623
Mailing Address - Country:US
Mailing Address - Phone:636-272-1444
Mailing Address - Fax:
Practice Address - Street 1:302 E PITMAN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2623
Practice Address - Country:US
Practice Address - Phone:636-272-1444
Practice Address - Fax:636-272-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001541Medicare ID - Type UnspecifiedGROUP NUMBER