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General NPI Number Information
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NPI Number | 1932227485
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Entity Type | Organization
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Legal Business Name | O'DONNELL EYE INSTITUTE, INC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 1034 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-7200
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Country | US
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Telephone | 314-821-4252
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Fax | 314-821-4080
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Provider Business Mailing Address
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Address Line | 1034 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-7200
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Country | US
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Telephone | 314-821-4252
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Fax | 314-821-4080
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Authorized Official
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Title or Position | PRESIDENT - CEO
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Name | DEBORAH L SWALLOW
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Credential |
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Telephone | 314-821-4252
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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 | T03150
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R9F62
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R9A10
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 103873
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License Number State | MO
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