Provider Demographics
NPI:1932374741
Name:OPTICAL EXPRESSIONS LLC
Entity Type:Organization
Organization Name:OPTICAL EXPRESSIONS LLC
Other - Org Name:OPTICAL EXPRESSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLINANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-579-0909
Mailing Address - Street 1:12422 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6392
Mailing Address - Country:US
Mailing Address - Phone:314-579-0909
Mailing Address - Fax:314-514-7413
Practice Address - Street 1:12422 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6392
Practice Address - Country:US
Practice Address - Phone:314-579-0909
Practice Address - Fax:314-514-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT3318152W00000X
MOM0T03318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1228940001Medicare PIN
MOU68202Medicare UPIN
MO1228940001Medicare NSC
MO000009304Medicare PIN