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NPI Code Detail

MEDICARE: DR. THOMAS J LANDGRAF OD

MEDICARE: DR. THOMAS J LANDGRAF OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1778TN
2152W00000XOptometrist2007030935MO

General Provider Information

NPI Number : 1427041615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS J LANDGRAF OD
Provider Business Mailing Address
First Line : 1 UNIVERSITY BLVD
Second Line : PATIENT CARE CENTER
City : SAINT LOUIS
State : MO
Zip : 63121-4400
Country : US
Telephone Number : 314-516-5131
Fax Number : 314-516-5507
Provider Business Practice Location Address
First Line : 7840 NATURAL BRIDGE RD
Second Line : PATIENT CARE CENTER
City : SAINT LOUIS
State : MO
Zip : 63121-4617
Country : US
Telephone Number : 314-516-5131
Fax Number : 314-516-5507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 06/10/2020

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