Healthcare Provider Details

I. General information

NPI: 1205856119
Provider Name (Legal Business Name): COMPREHENSIVE EYE CARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 3RD ST
WASHINGTON MO
63090-3010
US

IV. Provider business mailing address

901 E 3RD ST
WASHINGTON MO
63090-3010
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-3999
  • Fax: 636-390-3959
Mailing address:
  • Phone: 636-390-3999
  • Fax: 636-390-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberR1P88
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL S KORENFELD
Title or Position: PRESIDENT
Credential: MD
Phone: 636-390-3999