Healthcare Provider Details

I. General information

NPI: 1972023646
Provider Name (Legal Business Name): ARIEL MARION CERENZIE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL MARION JOHNSON OD

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4617
US

IV. Provider business mailing address

2424 W MALLARD CREEK CHURCH RD STE D
CHARLOTTE NC
28262-5800
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 TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2017017413
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2017017413
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2523
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: