Healthcare Provider Details

I. General information

NPI: 1942661186
Provider Name (Legal Business Name): ST LOUIS SOCIETY FOR THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 MANCHESTER RD
SAINT LOUIS MO
63144-2724
US

IV. Provider business mailing address

8770 MANCHESTER RD
SAINT LOUIS MO
63144-2724
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-9000
  • Fax: 314-968-9003
Mailing address:
  • Phone: 314-968-9000
  • Fax: 314-968-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C EKIN
Title or Position: PRESIDENT
Credential: ACSW
Phone: 314-968-9000