Healthcare Provider Details

I. General information

NPI: 1932414323
Provider Name (Legal Business Name): PIKUL OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MICHIGAN AVE
ARNOLD MO
63010-2151
US

IV. Provider business mailing address

103 BOGEY BLVD
ARNOLD MO
63010-6026
US

V. Phone/Fax

Practice location:
  • Phone: 636-287-6322
  • Fax: 636-287-6321
Mailing address:
  • Phone: 314-578-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2009017816
License Number StateMO

VIII. Authorized Official

Name: DR. JEFFREY THOMAS PIKUL
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 314-578-2578