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General NPI Number Information
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NPI Number | 1740602762
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Entity Type | Organization
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Legal Business Name | FENTON FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 1391 SMIZER MILL RD SUITE 102
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City | FENTON
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State | MO
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Zip | 63026-7306
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Country | US
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Telephone | 636-305-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 SMIZER MILL RD SUITE 102
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City | FENTON
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State | MO
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Zip | 63026-7306
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Country | US
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Telephone | 636-305-9600
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. VITO VRICELLA
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Credential | O.D.
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Telephone | 314-406-7014
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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 | 2010020480
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License Number State | MO
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