Healthcare Provider Details

I. General information

NPI: 1396334488
Provider Name (Legal Business Name): JACOB PIEPER O.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 DEER TRACKS TRL STE 130
SAINT LOUIS MO
63131-1854
US

IV. Provider business mailing address

1715 DEER TRACKS TRL STE 130
SAINT LOUIS MO
63131-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1856
  • Fax:
Mailing address:
  • Phone: 314-567-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB RAYMOND PIEPER
Title or Position: OWNER/PHYSICIAN
Credential: O.D.
Phone: 314-567-1856