Provider Demographics
NPI:1770737538
Name:CHABOT COMMUNITY EYE CARE
Entity type:Organization
Organization Name:CHABOT COMMUNITY EYE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-522-8773
Mailing Address - Street 1:301 S FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2737
Mailing Address - Country:US
Mailing Address - Phone:314-522-8773
Mailing Address - Fax:314-522-8556
Practice Address - Street 1:301 S FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2737
Practice Address - Country:US
Practice Address - Phone:314-522-8773
Practice Address - Fax:314-522-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile