Provider Demographics
NPI:1295030922
Name:O'FALLON FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:O'FALLON FAMILY EYE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEGYI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-775-7352
Mailing Address - Street 1:4142 KEATON CROSSING BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8403
Mailing Address - Country:US
Mailing Address - Phone:636-614-4655
Mailing Address - Fax:
Practice Address - Street 1:4142 KEATON CROSSING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8403
Practice Address - Country:US
Practice Address - Phone:636-614-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004030855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODS0330Medicare PIN
MOMA3332Medicare PIN