Healthcare Provider Details

I. General information

NPI: 1700010592
Provider Name (Legal Business Name): EYE CARE VISION CENTER II INC ERKERS KIRKWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 WASHINGTON SQ
WASHINGTON MO
63090-5302
US

IV. Provider business mailing address

1090 WASHINGTON SQUARE
WASHINGTON MO
63090
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-2020
  • Fax: 636-239-5766
Mailing address:
  • Phone: 636-239-2020
  • Fax: 636-239-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMO2593
License Number StateMO

VIII. Authorized Official

Name: DR. PETER M. GUBANY
Title or Position: PRESIDENT AND OPTOMETRIST
Credential: O.D.
Phone: 636-239-2020