MEDICARE: PFEIFFER FAMILY EYECARE 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1548950322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PFEIFFER FAMILY EYECARE LLC

Provider Business Mailing Address
First Line	:	315 DEEP WOODS DR
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-3446
Country	:	US
Telephone Number	:	636-234-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 N COMMERCIAL AVE STE 1
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1118
Country	:	US
Telephone Number	:	636-234-7587
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JONAH MICHAEL PFEIFFER
Credential	:	OD
Telephone Number	:	636-234-7587

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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