Provider Demographics
NPI:1184357949
Name:ZAGST, ALLISON CASEY JUSSEL (OD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:CASEY JUSSEL
Last Name:ZAGST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CASEY
Other - Last Name:JUSSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:657 W FRISCO AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3513
Mailing Address - Country:US
Mailing Address - Phone:512-484-9994
Mailing Address - Fax:
Practice Address - Street 1:7840 NATURAL BRIDGE RD
Practice Address - Street 2:
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:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022019440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist