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General NPI Number Information
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NPI Number | 1841426210
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Entity Type | Organization
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Legal Business Name | EYE & VISION REGENERATION GROUP, P.C.
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 219 CHESTERFIELD TOWNE CTR
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1257
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Country | US
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Telephone | 636-449-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 219 CHESTERFIELD TOWNE CTR
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1257
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Country | US
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Telephone | 636-449-7400
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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. EDWARD S. JARKA
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Credential | O.D.
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Telephone | 636-449-7400
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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 | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TO2796
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License Number State | MO
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