MEDICARE: CATARACT & GLAUCOMA EYE CENTER OF ST. LOUIS, LTD.

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	332H00000X	Eyewear Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0758290001	OTHER	MO	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1508041088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATARACT & GLAUCOMA EYE CENTER OF ST. LOUIS, LTD.

Provider Business Mailing Address
First Line	:	7220 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4404
Country	:	US
Telephone Number	:	314-352-5500
Fax Number	:	314-352-5500

Provider Business Practice Location Address
First Line	:	7220 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4404
Country	:	US
Telephone Number	:	314-352-5500
Fax Number	:	314-352-5500

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STANLEY CLIFFORD BECKER
Credential	:	M.D.
Telephone Number	:	314-352-5500

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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