Healthcare Provider Details

I. General information

NPI: 1255468898
Provider Name (Legal Business Name): ST. LOUIS EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12818 TESSON FERRY RD STE 102&104
SAINT LOUIS MO
63128-2613
US

IV. Provider business mailing address

12818 TESSON FERRY RD STE 102&104
SAINT LOUIS MO
63128-2613
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-9800
  • Fax: 314-352-4290
Mailing address:
  • Phone: 314-352-9800
  • Fax: 314-352-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV LELE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-352-9800