| NPI | 1043380652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M MACKEY Od VP 636-561-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03134) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03118) |
| 152W00000X Optometrist (Licence: MO 2003015589) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2009-06-17 |