Healthcare Provider Details

I. General information

NPI: 1134357882
Provider Name (Legal Business Name): JEFFREY THOMAS PIKUL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAPLEWOOD COMMONS DR
MAPLEWOOD MO
63143-1005
US

IV. Provider business mailing address

2201 MICHIGAN AVE
ARNOLD MO
63010-2151
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-1734
  • Fax: 314-781-0056
Mailing address:
  • Phone: 636-287-6322
  • Fax: 636-287-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2009017816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: