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General NPI Number Information
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NPI Number | 1609644350
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Entity Type | Organization
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Legal Business Name | OLTA CUCI
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 7437 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63119-4415
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Country | US
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Telephone | 314-687-1213
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Fax | 314-963-3215
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Provider Business Mailing Address
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Address Line | 6919 WILSTEAD DR
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City | SAINT LOUIS
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State | MO
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Zip | 63123-2251
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Country | US
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Telephone | 314-600-4023
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Fax | 314-963-3215
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Authorized Official
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Title or Position | DR.
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Name | OLTA CUCI
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Credential | OD
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Telephone | 314-600-4023
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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 |
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