Healthcare Provider Details

I. General information

NPI: 1831228071
Provider Name (Legal Business Name): CHABOT COMMUNITY EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 S FLORISSANT RD
FERGUSON MO
63135-2736
US

IV. Provider business mailing address

248 S FLORISSANT RD
FERGUSON MO
63135-2736
US

V. Phone/Fax

Practice location:
  • Phone: 314-522-8773
  • Fax:
Mailing address:
  • Phone: 314-522-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT CHABOT
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-522-8773