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General NPI Number Information
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NPI Number | 1073658290
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Entity Type | Organization
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Legal Business Name | THE OPTICAL SHOP OF WEST CLAY INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 2127 BLUESTONE DR SUITE 201
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6709
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Country | US
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Telephone | 636-947-0207
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Fax | 636-947-5996
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Provider Business Mailing Address
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Address Line | 2127 BLUESTONE DR SUITE 201
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6709
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Country | US
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Telephone | 636-947-0207
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Fax | 636-947-5996
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JANE TROUP
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Credential |
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Telephone | 636-947-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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