MEDICARE: AMERICAN EYEWEAR CENTER 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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist	MOT02606	MO

General Provider Information

NPI Number	:	1548654981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN EYEWEAR CENTER LLC

Provider Business Mailing Address
First Line	:	10275 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1103
Country	:	US
Telephone Number	:	314-962-9334
Fax Number	:	314-962-8248

Provider Business Practice Location Address
First Line	:	10275 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1103
Country	:	US
Telephone Number	:	314-962-9334
Fax Number	:	314-962-8248

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN M GOLDBERG
Credential	:	O.D.
Telephone Number	:	314-629-7667

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	06/16/2016

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Directions to “AMERICAN EYEWEAR CENTER LLC ” Practice Location

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