Healthcare Provider Details

I. General information

NPI: 1659799575
Provider Name (Legal Business Name): OPHTHALMOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 EXECUTIVE PARKWAY DR STE 200
SAINT LOUIS MO
63141-6340
US

IV. Provider business mailing address

PO BOX 736480
CHICAGO IL
60673-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-3201
  • Fax:
Mailing address:
  • Phone: 314-909-0633
  • Fax:

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: JOSEPH P GIRA
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 314-909-0633