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General NPI Number Information
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NPI Number | 1033277140
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Entity Type | Organization
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Legal Business Name | NU-CROWN, LLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 361 WINDING WOODS CTR SUITE 8
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City | O FALLON
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State | MO
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Zip | 63366-4170
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Country | US
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Telephone | 636-281-5367
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Fax | 800-432-6004
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Provider Business Mailing Address
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Address Line | 211 E BROADWAY
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City | ALTON
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State | IL
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Zip | 62002-6220
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Country | US
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Telephone | 800-407-2696
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Fax | 800-432-6004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS CHARLES D. MATTHEWS
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Credential |
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Telephone | 618-462-9818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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