Healthcare Provider Details

I. General information

NPI: 1588786750
Provider Name (Legal Business Name): THE LOW VISION CENTER OF ST LOUIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WATSON RD SUITE 2P
SAINT LOUIS MO
63126-1854
US

IV. Provider business mailing address

10000 WATSON RD SUITE 2P
SAINT LOUIS MO
63126-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-1140
  • Fax: 314-821-8324
Mailing address:
  • Phone: 314-821-1140
  • Fax: 314-821-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTO 2005
License Number StateMO

VIII. Authorized Official

Name: MS. RITA JOAN KNOX
Title or Position: OWNER
Credential:
Phone: 314-821-1140