Provider Demographics
NPI:1881002855
Name:RAY, VICTORIA PRICHODKO (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:PRICHODKO
Last Name:RAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:ROSE
Other - Last Name:PRICHODKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:2014-07-23
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014025418152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881002855Medicaid
MO074730039Medicare PIN
MO067820039Medicare PIN