Healthcare Provider Details

I. General information

NPI: 1205790128
Provider Name (Legal Business Name): DELIVERED VISION LABORATORY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N HIGHWAY 67 ST
FLORISSANT MO
63031-2915
US

IV. Provider business mailing address

845 N HIGHWAY 67 ST
FLORISSANT MO
63031-2915
US

V. Phone/Fax

Practice location:
  • Phone: 314-300-8104
  • Fax: 314-300-8114
Mailing address:
  • Phone: 314-300-8104
  • Fax: 314-300-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANTA KANICA MORRIS
Title or Position: OWNER
Credential:
Phone: 314-300-8104