Provider Demographics
NPI:1811244387
Name:EYE SHOPPE, INC.
Entity type:Organization
Organization Name:EYE SHOPPE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMMING-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-393-8888
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2826
Mailing Address - Country:US
Mailing Address - Phone:636-393-8888
Mailing Address - Fax:636-393-8404
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2826
Practice Address - Country:US
Practice Address - Phone:636-393-8888
Practice Address - Fax:636-393-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003105591261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center