Healthcare Provider Details

I. General information

NPI: 1902153067
Provider Name (Legal Business Name): SARA MAHSHID SERATI O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HAMPTON VILLAGE PLZ
SAINT LOUIS MO
63109-2127
US

IV. Provider business mailing address

34 HAMPTON VILLAGE PLZ
SAINT LOUIS MO
63109-2127
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-2679
  • Fax:
Mailing address:
  • Phone: 314-752-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2012021597
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2012021597
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: