Provider Demographics
NPI:1770879496
Name:WEST END EYES
Entity type:Organization
Organization Name:WEST END EYES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PLANK
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:314-367-1848
Mailing Address - Street 1:401 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1601
Mailing Address - Country:US
Mailing Address - Phone:314-367-1848
Mailing Address - Fax:314-367-1860
Practice Address - Street 1:401 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1601
Practice Address - Country:US
Practice Address - Phone:314-367-1848
Practice Address - Fax:314-367-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty