Provider Demographics
NPI:1851607279
Name:GARBO, AMY L (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:GARBO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:153 MARILLAC HALL
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-5131
Mailing Address - Fax:314-516-5507
Practice Address - Street 1:7800 NATURAL BRIDGE RD
Practice Address - Street 2:1 UNIVERSITY BLVD
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4617
Practice Address - Country:US
Practice Address - Phone:314-516-5131
Practice Address - Fax:314-516-5507
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2012-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010020582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO016300025Medicare PIN
MO067820032Medicare PIN
MO074730030Medicare PIN