Healthcare Provider Details

I. General information

NPI: 1831179670
Provider Name (Legal Business Name): BERNARD M KOVACS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CRESTWOOD PLZ
SAINT LOUIS MO
63126-1701
US

IV. Provider business mailing address

13 MEADOW LAKE DR
SAINT LOUIS MO
63146-5468
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-3660
  • Fax: 314-968-3559
Mailing address:
  • Phone: 314-432-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2003020949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: