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General NPI Number Information
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NPI Number | 1851454151
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Entity Type | Organization
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Legal Business Name | DOWNTOWN CLINIC OF OPTOMETRY, INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 720 OLIVE ST SUITE 420
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City | SAINT LOUIS
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State | MO
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Zip | 63101-2338
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Country | US
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Telephone | 314-231-0581
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Fax | 314-231-2690
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Provider Business Mailing Address
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Address Line | 720 OLIVE ST SUITE 420
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City | SAINT LOUIS
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State | MO
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Zip | 63101-2338
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Country | US
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Telephone | 314-231-0581
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Fax | 314-231-2690
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MORIO MIYAMOTO
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Credential | O.D.
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Telephone | 314-231-0581
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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 | T2320
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License Number State | MO
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