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General NPI Number Information
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NPI Number | 1215159504
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Entity Type | Organization
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Legal Business Name | MIDWEST EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 1384 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2444
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Country | US
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Telephone | 636-946-9242
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Fax | 636-946-4903
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Provider Business Mailing Address
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Address Line | 1384 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2444
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Country | US
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Telephone | 636-946-9242
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Fax | 636-946-4903
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Authorized Official
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Title or Position | OD/OWNER
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Name | BRADLEY A BYERGO
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Credential | OD
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Telephone | 508-837-3790
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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 |
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License Number State |
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