Healthcare Provider Details

I. General information

NPI: 1972738862
Provider Name (Legal Business Name): EYE CARE VISION CENTER II INC ERKERS KIRKWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-966-8587
  • Fax: 314-966-0650
Mailing address:
  • Phone: 314-966-8587
  • Fax: 314-966-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberT02593
License Number StateMO

VIII. Authorized Official

Name: DR. PETER M GUBANY
Title or Position: OWNER
Credential: O.D.
Phone: 314-966-8587