=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053448779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COUNTY OPHTHALMOLOGY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 S WOODS MILL RD SUITE 660N
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-878-9902
-----------------------------------------------------
Fax | 314-878-5112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 S WOODS MILL RD SUITE 660N
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-878-9902
-----------------------------------------------------
Fax | 314-878-5112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD C BILCHIK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 314-878-9902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------