MEDICARE: DR. ELIOT G MASEK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046010396	IL
2	152WL0500X	Low Vision Rehabilitation Optometrist	046010396	IL
3	152WL0500X	Low Vision Rehabilitation Optometrist	2011037694	MO
4	152W00000X	Optometrist	2011037694	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134432149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIOT G MASEK O.D.

Provider Business Mailing Address
First Line	:	40 E NORTH ST
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-1205
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-938-2650

Provider Business Practice Location Address
First Line	:	537 W KARSCH BLVD
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3312
Country	:	US
Telephone Number	:	573-747-4133
Fax Number	:	573-747-4533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	10/02/2014

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