1588786750 NPI number — THE LOW VISION CENTER OF ST LOUIS INC

Table of content: (NPI 1588786750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588786750 NPI number — THE LOW VISION CENTER OF ST LOUIS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LOW VISION CENTER OF ST LOUIS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588786750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10000 WATSON RD
Provider Second Line Business Mailing Address:
SUITE 2P
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63126-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-821-1140
Provider Business Mailing Address Fax Number:
314-821-8324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 WATSON RD
Provider Second Line Business Practice Location Address:
SUITE 2P
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63126-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-821-1140
Provider Business Practice Location Address Fax Number:
314-821-8324
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KNOX
Authorized Official First Name:
RITA
Authorized Official Middle Name:
JOAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-821-1140

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  TO 2005 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108637 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 22-02036 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MO 92005 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 32395 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 33933 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262003 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 400681 . This is a "ADVANTRA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 16601 . This is a "SPECTERA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 32395 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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