Healthcare Provider Details

I. General information

NPI: 1952725210
Provider Name (Legal Business Name): ALTENBERND FAMILY EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 TELEGRAPH RD SUITE 119
SAINT LOUIS MO
63129-3500
US

IV. Provider business mailing address

5445 TELEGRAPH RD SUITE 119
SAINT LOUIS MO
63129-3500
US

V. Phone/Fax

Practice location:
  • Phone: 314-845-0770
  • Fax: 314-845-0814
Mailing address:
  • Phone: 314-845-0770
  • Fax: 314-845-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTO3366
License Number StateMO

VIII. Authorized Official

Name: DR. THOMAS WILLIAM ALTENBERND
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 314-477-0314