Provider Demographics
NPI:1134161888
Name:EYE CARE ASSOCIATES OF ST LOUIS LLC
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES OF ST LOUIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-863-4200
Mailing Address - Street 1:15 THE BOULEVARD SAINT LOUIS
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1118
Mailing Address - Country:US
Mailing Address - Phone:314-863-4200
Mailing Address - Fax:314-863-3570
Practice Address - Street 1:15 THE BOULEVARD SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1118
Practice Address - Country:US
Practice Address - Phone:314-863-4200
Practice Address - Fax:314-863-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0843110001Medicare NSC
MO990001010Medicare ID - Type Unspecified