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General NPI Number Information
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NPI Number | 1811244387
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Entity Type | Organization
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Legal Business Name | EYE SHOPPE, INC.
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 115 N MAIN ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2826
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Country | US
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Telephone | 636-393-8888
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Fax | 636-393-8404
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Provider Business Mailing Address
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Address Line | 115 N MAIN ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2826
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Country | US
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Telephone | 636-393-8888
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Fax | 636-393-8404
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JULIE L. EMMING-THOMAS
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Credential | OD
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Telephone | 636-393-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2003105591
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License Number State | MO
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