Healthcare Provider Details

I. General information

NPI: 1881002855
Provider Name (Legal Business Name): VICTORIA PRICHODKO RAY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ROSE PRICHODKO O.D.

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NATURAL BRIDGE RD 1 UNIVERSITY BLVD
SAINT LOUIS MO
63121-4617
US

IV. Provider business mailing address

1 UNIVERSITY BLVD 153 MARILLAC HALL
SAINT LOUIS MO
63121-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5131
  • Fax: 314-516-5507
Mailing address:
  • Phone: 314-516-5131
  • Fax: 314-516-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2014025418
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2014025418
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: