Provider Demographics
NPI:1861469918
Name:POLLOCK, CONNIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:M
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:5694 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4243
Practice Address - Country:US
Practice Address - Phone:314-846-4222
Practice Address - Fax:800-432-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
108710OtherBLUE CROSS BLUE SHIELD MO
12453OtherOPTICARE MEDICARE COMPLET
340370OtherHEALTHLINK
IL410048091OtherRR MEDICARE
5217OtherDAVIS VISION
T92390OtherMERCY HEALTH PLAN
MOP00305305OtherRR MEDICARE
110977OtherEYEMED
MO310754627Medicaid
MO4197OtherHEALTHCARE USA
22-00135OtherUNITED HEALTHCARE
22-00135OtherUNITED HEALTHCARE
MO4197OtherHEALTHCARE USA
110977OtherEYEMED