Healthcare Provider Details

I. General information

NPI: 1528981362
Provider Name (Legal Business Name): KIRKWOOD FAMILY EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W JEFFERSON AVE STE 106
KIRKWOOD MO
63122-4064
US

IV. Provider business mailing address

124 W JEFFERSON AVE STE 106
KIRKWOOD MO
63122-4064
US

V. Phone/Fax

Practice location:
  • Phone: 618-791-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEX AMANN
Title or Position: OWNER
Credential: OD
Phone: 618-791-9455