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General NPI Number Information
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NPI Number | 1063526804
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Entity Type | Organization
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Legal Business Name | ST CHARLES EYE CENTER INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 1005 FAIRGROUNDS RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2338
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Country | US
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Telephone | 636-724-7116
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Fax | 636-916-4627
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Provider Business Mailing Address
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Address Line | 1005 FAIRGROUNDS RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2338
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Country | US
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Telephone | 636-724-7116
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Fax | 636-916-4627
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANN C KNICHEL
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Credential |
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Telephone | 636-724-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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