| NPI | 1700175395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY DEISS Credentialing Specialist 314-367-1181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2025-02-21 |