Healthcare Provider Details

I. General information

NPI: 1134237365
Provider Name (Legal Business Name): THOMAS WILLIAM ALTENBERND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLIFF CAVE RD STE 100
SAINT LOUIS MO
63129-3611
US

IV. Provider business mailing address

111 CLIFF CAVE RD STE 100
SAINT LOUIS MO
63129-3611
US

V. Phone/Fax

Practice location:
  • Phone: 314-846-8232
  • Fax: 314-845-0814
Mailing address:
  • Phone: 314-846-8232
  • Fax: 314-845-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3366
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTO3366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: