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General NPI Number Information
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NPI Number | 1205825080
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Entity Type | Individual
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Provider Name | ERIN CLEARY SULLIVAN OD
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Gender | Female
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD OPHTHALMOLOGY CONSULTANTS LTD STE 5006B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-432-5478
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Fax | 314-569-0864
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Provider Business Mailing Address
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Address Line | 621 S NEW BALLAS RD STE 5006B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-432-5478
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Fax | 314-569-0864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2003015404
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License Number State | MO
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