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General NPI Number Information
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NPI Number | 1891294948
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Entity Type | Individual
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Provider Name | CORINNE LAURA LIGE B.C.O.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 2821 N BALLAS RD STE C30
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2393
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Country | US
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Telephone | 314-567-7585
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Fax | 314-567-7083
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Provider Business Mailing Address
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Address Line | 2821 N BALLAS RD STE C30
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2393
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Country | US
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Telephone | 314-567-7585
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Fax | 314-567-7083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | 09-318-21
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License Number State | MO
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