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General NPI Number Information
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NPI Number | 1225211477
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Entity Type | Organization
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Legal Business Name | PEPOSE VISION INSTITUTE, PC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 1815 CLARKSON ROAD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5065
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Country | US
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Telephone | 636-728-0111
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Fax | 636-728-0093
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Provider Business Mailing Address
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Address Line | 1815 CLARKSON ROAD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5065
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Country | US
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Telephone | 636-728-0111
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Fax | 636-728-0093
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAY STUART PEPOSE
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Credential | M.D., PHD.
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Telephone | 636-728-0111
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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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