=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083887053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE SPECIALISTS OF SAINT CHARLES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2008
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 1ST CAPITOL DR SUITE 330
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-947-3937
-----------------------------------------------------
Fax | 636-947-9425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 FIRST CAPITOL DRIVE SUITE 330
-----------------------------------------------------
City | ST. CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-947-3937
-----------------------------------------------------
Fax | 636-947-9425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONALD STEVEN LEVY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 314-374-0510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MDR4662
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------