=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174498190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUNGLE BUSSINESS VISION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8306 WASHINGTON ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63114-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-449-4969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4032 HARTFORD ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63116-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-203-6477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MICHELLE WEBB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-203-6477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------