Provider Demographics
NPI:1881823334
Name:SAINT PETERS EYE CARE CENTER LTD.
Entity Type:Organization
Organization Name:SAINT PETERS EYE CARE CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GREELEY
Authorized Official - Last Name:LYDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-397-2020
Mailing Address - Street 1:6764 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1505
Mailing Address - Country:US
Mailing Address - Phone:636-397-2020
Mailing Address - Fax:636-278-2040
Practice Address - Street 1:6764 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1505
Practice Address - Country:US
Practice Address - Phone:636-397-2020
Practice Address - Fax:636-278-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6250720001Medicare NSC
MOMA1309Medicare PIN