MEDICARE: THE KOETTING ASSOCIATES 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

General Provider Information

NPI Number	:	1629106620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KOETTING ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2511 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2308
Country	:	US
Telephone Number	:	314-863-0000
Fax Number	:	314-961-1041

Provider Business Practice Location Address
First Line	:	2511 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2308
Country	:	US
Telephone Number	:	314-863-0000
Fax Number	:	314-961-1041

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARMEN F CASTELLANO
Credential	:	O.D.
Telephone Number	:	314-863-0000

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/11/2016

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