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General NPI Number Information
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NPI Number | 1548683915
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Entity Type | Organization
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Legal Business Name | LIBERTY EYECARE LLC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD
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City | ST LOUIS
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State | MO
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Zip | 63141
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Country | US
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Telephone | 314-251-6430
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Fax | 314-251-4392
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Provider Business Mailing Address
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Address Line | 17714 CHESTERFIELD AIRPORT RD
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1212
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Country | US
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Telephone | 781-708-3102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA MAHSHID SERATI
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Credential | OD
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Telephone | 781-708-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2012021597
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License Number State | MO
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