Healthcare Provider Details

I. General information

NPI: 1619470945
Provider Name (Legal Business Name): OVITSKY VISION CARE OF MISSOURI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHESTERFIELD BUSINESS PKWY
CHESTERFIELD MO
63005-1271
US

IV. Provider business mailing address

100 CHESTERFIELD BUSINESS PKWY
CHESTERFIELD MO
63005-1271
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-3090
  • Fax:
Mailing address:
  • Phone: 773-588-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL OVITSKY
Title or Position: VICE PRESIDENT
Credential:
Phone: 773-588-3090