Healthcare Provider Details

I. General information

NPI: 1184357949
Provider Name (Legal Business Name): ALLISON CASEY JUSSEL ZAGST OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON CASEY JUSSEL

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4617
US

IV. Provider business mailing address

657 W FRISCO AVE
WEBSTER GROVES MO
63119-3513
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5131
  • Fax:
Mailing address:
  • Phone: 512-484-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2022019440
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: