Healthcare Provider Details

I. General information

NPI: 1386820819
Provider Name (Legal Business Name): HERMANN/WASHINGTON EYE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E 1ST ST
HERMANN MO
65041-1114
US

IV. Provider business mailing address

228 E 1ST ST
HERMANN MO
65041-1114
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-7722
  • Fax: 636-239-7622
Mailing address:
  • Phone: 636-239-7722
  • Fax: 636-239-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO2265
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberTO2265
License Number StateMO

VIII. Authorized Official

Name: DR. GARY J GIESLER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 636-239-7722