Healthcare Provider Details

I. General information

NPI: 1396185427
Provider Name (Legal Business Name): TRISTA PABISZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 S 5TH ST
SAINT CHARLES MO
63301-2444
US

IV. Provider business mailing address

1401 TRIAD CENTER DR
SAINT PETERS MO
63376-7353
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-9242
  • Fax: 636-946-4903
Mailing address:
  • Phone: 636-441-8010
  • Fax: 636-441-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2013021145
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: