Healthcare Provider Details

I. General information

NPI: 1114217536
Provider Name (Legal Business Name): OPHTHALMOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12692 LAMPLIGHTER SQUARE SHPG CTR
SAINT LOUIS MO
63128-2746
US

IV. Provider business mailing address

12990 MANCHESTER RD STE 201
DES PERES MO
63131-1860
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-5478
  • Fax: 314-569-0864
Mailing address:
  • Phone: 314-909-0633
  • Fax: 314-569-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH P GIRA
Title or Position: OWNER
Credential: M.D.
Phone: 314-909-0633