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General NPI Number Information
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NPI Number | 1992442214
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Entity Type | Organization
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Legal Business Name | FOUR CIRCLES VISION THERAPY
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 3449 PHEASANT MEADOW DR STE 100
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City | O FALLON
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State | MO
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Zip | 63368-7364
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Country | US
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Telephone | 636-294-3197
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Fax | 855-812-9227
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Provider Business Mailing Address
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Address Line | 3449 PHEASANT MEADOW DR STE 100
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City | O FALLON
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State | MO
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Zip | 63368-7364
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Country | US
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Telephone | 636-294-3197
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Fax | 855-812-9227
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JEFFREY JAMES LANT
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Credential | OD
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Telephone | 636-294-3197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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