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General NPI Number Information
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NPI Number | 1891358115
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Entity Type | Organization
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Legal Business Name | ESSENTIAL EYECARE, LLC
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 7256 PERSHING AVE UNIT B
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4248
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Country | US
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Telephone | 314-494-1125
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Fax | 314-863-7586
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Provider Business Mailing Address
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Address Line | 7256 PERSHING AVE UNIT B
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4248
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Country | US
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Telephone | 314-494-1125
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Fax | 314-863-7586
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | FRANK WASSERMAN
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Credential | OD
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Telephone | 314-494-1125
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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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