1457564189 NPI number — TLC MIDWEST EYE LASER CENTER INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457564189 NPI number — TLC MIDWEST EYE LASER CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC MIDWEST EYE LASER CENTER 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:
6
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:
1457564189
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:
16305 SWINGLEY RIDGE RD
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-1777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-534-2300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 WESTBROOK CORPORATE CTR
Provider Second Line Business Practice Location Address:
STE. 111
Provider Business Practice Location Address City Name:
WESTCHESTER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60154-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-562-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREW
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
636-534-2300

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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