Provider Demographics
NPI:1932227485
Name:O'DONNELL EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:O'DONNELL EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-821-4252
Mailing Address - Street 1:1034 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7200
Mailing Address - Country:US
Mailing Address - Phone:314-821-4252
Mailing Address - Fax:314-821-4080
Practice Address - Street 1:1034 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7200
Practice Address - Country:US
Practice Address - Phone:314-821-4252
Practice Address - Fax:314-821-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03150152W00000X
MOR9F62174400000X
MO103873174400000X
MOR9A10174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10165COtherANTHEM BCBS HEALTH PLAN
MO35724OtherCMR GROUP HEALTH PLAN
MO34824OtherGROUP HEALTH PLAN
MO502893704Medicaid
MO000011455Medicare ID - Type Unspecified