1932227485 NPI number — O'DONNELL EYE INSTITUTE, INC.

Table of content: (NPI 1932227485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932227485 NPI number — O'DONNELL EYE INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'DONNELL EYE INSTITUTE, 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:
1932227485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 S KIRKWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-821-4252
Provider Business Mailing Address Fax Number:
314-821-4080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 S KIRKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-821-4252
Provider Business Practice Location Address Fax Number:
314-821-4080
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWALLOW
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT - CEO
Authorized Official Telephone Number:
314-821-4252

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T03150 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: R9F62 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 103873 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: R9A10 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10165C . This is a "ANTHEM BCBS HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 35724 . This is a "CMR GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 34824 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 502893704 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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