| NPI | 1558768440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY L SHORT Credentialing Manager 618-462-9818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T02999) |
| 152W00000X Optometrist | |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2018-06-28 |