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General NPI Number Information
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NPI Number | 1275539173
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Entity Type | Organization
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Legal Business Name | COMPLETE EYE CARE, INC.
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 9890 CLAYTON RD SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-395-9613
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Fax | 314-395-9621
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Provider Business Mailing Address
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Address Line | 9890 CLAYTON RD SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-395-9613
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Fax | 314-395-9621
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LISA JEAN TYCHSEN
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Credential |
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Telephone | 314-395-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | MO
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