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General NPI Number Information
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NPI Number | 1720783830
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Entity Type | Organization
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Legal Business Name | MISSOURI VISION CARE
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 2100 COLLIER CORPORATE PKWY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6708
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Country | US
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Telephone | 314-239-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 COLLIER CORPORATE PKWY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6708
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Country | US
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Telephone | 314-239-5859
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEBE BAGWASI
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Credential | OD
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Telephone | 314-239-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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