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General NPI Number Information
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NPI Number | 1790641884
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Entity Type | Organization
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Legal Business Name | THEODORE K SULLIVAN, OD, LLC
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1 MERAMEC BLUFFS DR
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City | BALLWIN
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State | MO
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Zip | 63021-3309
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Country | US
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Telephone | 636-861-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 9015 EAGER RD APT 119
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1109
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Country | US
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Telephone | 314-478-3669
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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. THEODORE K SULLIVAN
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Credential | OD
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Telephone | 314-478-3669
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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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