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General NPI Number Information
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NPI Number | 1427551894
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Entity Type | Organization
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Legal Business Name | TARY VISION LLC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 17 RONNIES PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63126-3552
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Country | US
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Telephone | 314-843-2020
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Fax | 314-843-2021
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Provider Business Mailing Address
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Address Line | 844 KONERT HILL DR
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City | FENTON
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State | MO
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Zip | 63026-7176
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Country | US
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Telephone | 636-208-2832
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | ASHLEY NICOLE TARY
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Credential | OD
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Telephone | 636-208-2832
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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 | 2014018412
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License Number State | MO
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