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General NPI Number Information
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NPI Number | 1285891622
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Entity Type | Organization
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Legal Business Name | EYE SURGEONS AND PHYSICIANS OF ST LOUIS LTD
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 3454 MCKELVEY RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2533
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Country | US
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Telephone | 314-469-1122
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Fax | 314-822-6281
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Provider Business Mailing Address
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Address Line | 2315 DOUGHERTY FERRY RD SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3383
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Country | US
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Telephone | 314-469-1122
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Fax | 314-822-6281
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK HARTSTEIN
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Credential | MD
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Telephone | 314-469-1122
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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 | R1168
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License Number State | MO
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