Healthcare Provider Details

I. General information

NPI: 1609956416
Provider Name (Legal Business Name): LISA K FOLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13455 MANCHESTER RD
SAINT LOUIS MO
63131-1711
US

IV. Provider business mailing address

956 FORESTLAC CT
SAINT LOUIS MO
63141-6015
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-4423
  • Fax: 314-822-5541
Mailing address:
  • Phone: 636-346-9262
  • Fax: 314-822-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2001029920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: