Healthcare Provider Details

I. General information

NPI: 1477968329
Provider Name (Legal Business Name): PARKER STEVEN BERG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2014
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SALT LICK RD
SAINT PETERS MO
63376-5974
US

IV. Provider business mailing address

PO BOX 207158
DALLAS TX
75320-7158
US

V. Phone/Fax

Practice location:
  • Phone: 636-970-0250
  • Fax: 636-279-1061
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2016015179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: