Healthcare Provider Details

I. General information

NPI: 1992742498
Provider Name (Legal Business Name): CHERRY HILLS FAMILY EYE CARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16508 MANCHESTER RD
WILDWOOD MO
63040-1217
US

IV. Provider business mailing address

16508 MANCHESTER RD
WILDWOOD MO
63040-1217
US

V. Phone/Fax

Practice location:
  • Phone: 636-273-6336
  • Fax: 636-273-9172
Mailing address:
  • Phone: 636-273-6336
  • Fax: 636-273-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3447
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID PAUL PRANGE
Title or Position: OWNER
Credential: O.D.
Phone: 636-273-6336