Healthcare Provider Details

I. General information

NPI: 1235918673
Provider Name (Legal Business Name): LAZARUS EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 CAROLINE DR
HIGH RIDGE MO
63049-2481
US

IV. Provider business mailing address

5311 CAROLINE DR
HIGH RIDGE MO
63049-2481
US

V. Phone/Fax

Practice location:
  • Phone: 314-640-0843
  • Fax:
Mailing address:
  • Phone: 636-489-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MATTHEW RYAN LAZARUS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 636-489-0133