Healthcare Provider Details

I. General information

NPI: 1649840059
Provider Name (Legal Business Name): JONAH MICHAEL PFEIFFER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N COMMERCIAL AVE STE 1
SAINT CLAIR MO
63077-1118
US

IV. Provider business mailing address

855 N COMMERCIAL AVE
SAINT CLAIR MO
63077-1118
US

V. Phone/Fax

Practice location:
  • Phone: 636-812-6789
  • Fax: 636-812-6788
Mailing address:
  • Phone: 636-812-6789
  • Fax: 636-812-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2021019773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: