Healthcare Provider Details

I. General information

NPI: 1760474662
Provider Name (Legal Business Name): JERRI L BIRSINGER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 JEFFCO BLVD
ARNOLD MO
63010-2713
US

IV. Provider business mailing address

1781 JEFFCO BLVD
ARNOLD MO
63010-2713
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-5008
  • Fax: 636-333-3093
Mailing address:
  • Phone: 636-200-5008
  • Fax: 636-333-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03357
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT03357
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberT03357
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: