Healthcare Provider Details

I. General information

NPI: 1831173145
Provider Name (Legal Business Name): FERGUSON OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 HOWDERSHELL RD STE H
HAZELWOOD MO
63042-3811
US

IV. Provider business mailing address

7025 HOWDERSHELL RD STE H
HAZELWOOD MO
63042-3811
US

V. Phone/Fax

Practice location:
  • Phone: 314-731-1117
  • Fax: 314-731-7122
Mailing address:
  • Phone: 314-731-1117
  • Fax: 314-731-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTIN E LITTLE
Title or Position: CORPORATE OFFICER
Credential: OPTICIAN
Phone: 314-731-1117