Healthcare Provider Details

I. General information

NPI: 1629771407
Provider Name (Legal Business Name): SUCCESS VISION EXPRESS OF MAPLEWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MAPLEWOOD COMMONS DR
SAINT LOUIS MO
63143-1003
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 314-860-2020
  • Fax:
Mailing address:
  • Phone: 918-800-2020
  • Fax: 877-464-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD PRESLEY
Title or Position: OWNER
Credential:
Phone: 918-800-2020