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General NPI Number Information
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NPI Number | 1417049610
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Entity Type | Organization
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Legal Business Name | CURATORS OF THE UNIVERSITY OF MISSOURI
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 601 JAMES R. THOMPSON BLVD BUILDING D, STE 2030
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City | EAST ST. LOUIS
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State | IL
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Zip | 62201-1129
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Country | US
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Telephone | 618-482-8355
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Fax | 618-482-8360
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Provider Business Mailing Address
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Address Line | 1 UNIVERSITY BLVD PATIENT CARE CENTER
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City | SAINT LOUIS
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State | MO
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Zip | 63121-4400
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Country | US
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Telephone | 314-516-5131
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Fax | 314-516-5507
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | DR. VINITA A HENRY
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Credential | OD
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Telephone | 314-516-6532
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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 | IL
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