Provider Demographics
NPI:1942497805
Name:OPHTHALMIC PLASTIC & COSMETIC SURGERY, INC.
Entity Type:Organization
Organization Name:OPHTHALMIC PLASTIC & COSMETIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-567-3567
Mailing Address - Street 1:12990 MANCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1804
Mailing Address - Country:US
Mailing Address - Phone:314-567-3567
Mailing Address - Fax:314-567-6575
Practice Address - Street 1:12990 MANCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1804
Practice Address - Country:US
Practice Address - Phone:314-567-3567
Practice Address - Fax:314-567-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR3N98174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty