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General NPI Number Information
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NPI Number | 1760404560
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Entity Type | Organization
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Legal Business Name | ADVANCED SIGHT CENTER, INC
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12601 OLIVE BLVD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6313
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Country | US
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Telephone | 314-878-4228
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Fax | 314-878-7747
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Provider Business Mailing Address
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Address Line | 12601 OLIVE BLVD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6313
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Country | US
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Telephone | 314-878-4228
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Fax | 314-878-7747
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOWARD NEWTON SHORT
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Credential | MD
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Telephone | 314-878-4228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | R9366
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License Number State | MO
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