Healthcare Provider Details

I. General information

NPI: 1538752811
Provider Name (Legal Business Name): GATEWAY LOW VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW BALLAS RD STE 120
CREVE COEUR MO
63141-6820
US

IV. Provider business mailing address

8031 GANNON AVE
SAINT LOUIS MO
63130-3710
US

V. Phone/Fax

Practice location:
  • Phone: 833-376-6445
  • Fax: 314-312-6984
Mailing address:
  • Phone: 833-376-6445
  • Fax: 314-228-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MOGIL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 314-328-9919