Healthcare Provider Details

I. General information

NPI: 1487221404
Provider Name (Legal Business Name): EYE SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10296 BIG BEND RD STE 100
SAINT LOUIS MO
63122-6425
US

IV. Provider business mailing address

10296 BIG BEND RD STE 100
SAINT LOUIS MO
63122-6425
US

V. Phone/Fax

Practice location:
  • Phone: 314-735-0200
  • Fax:
Mailing address:
  • Phone: 314-735-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAVIN TEKWANI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 314-735-0200