Provider Demographics
NPI:1851444517
Name:SUREVISION EYE CENTERS MIDWEST LLC
Entity Type:Organization
Organization Name:SUREVISION EYE CENTERS MIDWEST LLC
Other - Org Name:SUREVISION OPTICAL SHOPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MIANA
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:314-726-5669
Mailing Address - Street 1:320 BROOKES DR
Mailing Address - Street 2:STE 111
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-726-5669
Mailing Address - Fax:314-726-5109
Practice Address - Street 1:12101 WOODCREST EXECUTIVE DR STE 150
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5050
Practice Address - Country:US
Practice Address - Phone:314-921-2020
Practice Address - Fax:314-863-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1309310001Medicare NSC