Healthcare Provider Details

I. General information

NPI: 1417315706
Provider Name (Legal Business Name): OM VISION SERVICES INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13329 MANCHESTER RD
DES PERES MO
63131-1710
US

IV. Provider business mailing address

13329 MANCHESTER RD
DES PERES MO
63131-1710
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-4435
  • Fax:
Mailing address:
  • Phone: 314-965-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateCA

VIII. Authorized Official

Name: STELLA ZILBER
Title or Position: OFFICER/OWNER
Credential: OWNER
Phone: 214-912-7272