Healthcare Provider Details

I. General information

NPI: 1770879496
Provider Name (Legal Business Name): WEST END EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EUCLID AVE
SAINT LOUIS MO
63108-1601
US

IV. Provider business mailing address

401 N EUCLID AVE
SAINT LOUIS MO
63108-1601
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-1848
  • Fax: 314-367-1860
Mailing address:
  • Phone: 314-367-1848
  • Fax: 314-367-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY L PLANK
Title or Position: OWNER/OPTICIAN
Credential: ABO
Phone: 314-367-1848