MEDICARE: WEST END EYES

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
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1770879496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST END EYES

Provider Business Mailing 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	:	314-367-1860

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	:	314-367-1860

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	MRS. STACEY L PLANK
Credential	:	ABO
Telephone Number	:	314-367-1848

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

Similar Medicare Providers

1114254281 — DR. SONIA SALAS O.D.
Practice Location Address:

401 N EUCLID AVE
SAINT LOUIS, MO
63108-1601

Practice Phone: 314-367-1848
Practice Fax:

1407138332 — ANDREA DECKER MS, RD, LD
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1487214961 — EMILY C O'BRIEN OD
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1376201715 — BLACK OPTICAL LLC
Practice Location Address:

401 N EUCLID AVE
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1164413993 — OZIK ADULT HEALTHCARE SERVICES
Practice Location Address:

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1558422709 — BRONWEN CAMERON DIANTONIO PH.D.
Practice Location Address:

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Directions to “WEST END EYES ” Practice Location

Language	Start Address	Practice Location

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