Healthcare Provider Details

I. General information

NPI: 1497019939
Provider Name (Legal Business Name): TLC VISION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 JONES BRANCH DR
MC LEAN VA
22102-3388
US

IV. Provider business mailing address

16305 SWINGLEY RIDGE RD STE 300
CHESTERFIELD MO
63017-1777
US

V. Phone/Fax

Practice location:
  • Phone: 703-761-4999
  • Fax: 703-761-4960
Mailing address:
  • Phone: 636-534-2300
  • Fax: 636-489-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARICE Y ANDERSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 636-534-2234