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General NPI Number Information
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NPI Number | 1992742498
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Entity Type | Organization
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Legal Business Name | CHERRY HILLS FAMILY EYE CARE, L.L.C.
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 16508 MANCHESTER RD
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City | WILDWOOD
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State | MO
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Zip | 63040-1217
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Country | US
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Telephone | 636-273-6336
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Fax | 636-273-9172
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Provider Business Mailing Address
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Address Line | 16508 MANCHESTER RD
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City | WILDWOOD
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State | MO
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Zip | 63040-1217
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Country | US
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Telephone | 636-273-6336
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Fax | 636-273-9172
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID PAUL PRANGE
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Credential | O.D.
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Telephone | 636-273-6336
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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 | TO3447
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License Number State | MO
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