Provider Demographics
NPI:1952725210
Name:ALTENBERND FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:ALTENBERND FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ALTENBERND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-477-0314
Mailing Address - Street 1:5445 TELEGRAPH RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3500
Mailing Address - Country:US
Mailing Address - Phone:314-845-0770
Mailing Address - Fax:314-845-0814
Practice Address - Street 1:5445 TELEGRAPH RD
Practice Address - Street 2:SUITE 119
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3500
Practice Address - Country:US
Practice Address - Phone:314-845-0770
Practice Address - Fax:314-845-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3366152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty