Healthcare Provider Details

I. General information

NPI: 1639484405
Provider Name (Legal Business Name): OLTA CUCI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 TELEGRAPH RD
SAINT LOUIS MO
63125-2515
US

IV. Provider business mailing address

1900 TELEGRAPH RD
SAINT LOUIS MO
63125-2515
US

V. Phone/Fax

Practice location:
  • Phone: 314-582-1757
  • Fax: 314-582-1965
Mailing address:
  • Phone: 314-582-1757
  • Fax: 314-582-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2010028087
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: