Healthcare Provider Details

I. General information

NPI: 1609644350
Provider Name (Legal Business Name): OLTA CUCI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 WATSON RD
SAINT LOUIS MO
63119-4415
US

IV. Provider business mailing address

6919 WILSTEAD DR
SAINT LOUIS MO
63123-2251
US

V. Phone/Fax

Practice location:
  • Phone: 314-687-1213
  • Fax: 314-963-3215
Mailing address:
  • Phone: 314-600-4023
  • Fax: 314-963-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OLTA CUCI
Title or Position: DR.
Credential: OD
Phone: 314-600-4023