MEDICARE: DR. APRIL THACKER-SALVADOR OD

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	2004020059	MO

General Provider Information

NPI Number	:	1417985748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APRIL THACKER-SALVADOR OD

Provider Business Mailing Address
First Line	:	842 N. NEW BALLAS CT # 401
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141
Country	:	US
Telephone Number	:	314-989-9755
Fax Number	:	314-845-5956

Provider Business Practice Location Address
First Line	:	4305 BUTLER HILL RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3717
Country	:	US
Telephone Number	:	314-487-4744
Fax Number	:	314-845-5956

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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