Healthcare Provider Details

I. General information

NPI: 1417075722
Provider Name (Legal Business Name): WOLF AND WOLF OPTOMETRISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-846-8232
  • Fax: 314-846-2428
Mailing address:
  • Phone: 314-846-8232
  • Fax: 314-846-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL L WOLF
Title or Position: DOCTOR OWNER
Credential: OD
Phone: 314-846-8232