Healthcare Provider Details

I. General information

NPI: 1255867149
Provider Name (Legal Business Name): JESSICA TU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S KIRKWOOD RD STE 130
KIRKWOOD MO
63122-4335
US

IV. Provider business mailing address

804 NANDINA GREEN DR
O FALLON IL
62269-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-3045
  • Fax: 314-394-3049
Mailing address:
  • Phone: 787-628-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046012138
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2018034549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: