MEDICARE: EMILY C O'BRIEN 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
1	152W00000X	Optometrist	2019021325	MO

General Provider Information

NPI Number	:	1487214961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY C O'BRIEN OD

Provider Business Mailing Address
First Line	:	401 N EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1601
Country	:	US
Telephone Number	:	143-671-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1601
Country	:	US
Telephone Number	:	314-367-1848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	11/24/2021

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Directions to “ EMILY C O'BRIEN OD” Practice Location

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