MEDICARE: TLC WHITTEN LASER EYE CARE, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215142484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC WHITTEN LASER EYE CARE, LLC

Provider Business Mailing Address
First Line	:	16305 SWINGLEY RIDGE RD
Second Line	:	STE. 300
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-1777
Country	:	US
Telephone Number	:	636-534-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	46169 WESTLAKE DR
Second Line	:	STE. 240
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-444-4990
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	BRIAN L ANDREW
Credential	:
Telephone Number	:	636-534-2300

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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