MEDICARE: AFFORDABLE EYECARE, INC

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
1	152W00000X	Optometrist	T03207	MO

General Provider Information

NPI Number	:	1457636912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE EYECARE, INC

Provider Business Mailing Address
First Line	:	6975 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2540
Country	:	US
Telephone Number	:	314-863-3937
Fax Number	:	314-721-2698

Provider Business Practice Location Address
First Line	:	6975 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2540
Country	:	US
Telephone Number	:	314-863-3937
Fax Number	:	314-721-2698

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT SMITH
Credential	:	OD
Telephone Number	:	314-863-3937

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	07/06/2012

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Directions to “AFFORDABLE EYECARE, INC ” Practice Location

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