MEDICARE: ERNEST C DOIRON O.D.

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	046009847	IL

General Provider Information

NPI Number	:	1558458521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST C DOIRON O.D.

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD
Second Line	:	STE 201
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-938-2650

Provider Business Practice Location Address
First Line	:	4412 TELEGRAPH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-3316
Country	:	US
Telephone Number	:	314-894-5353
Fax Number	:	314-416-1144

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	06/09/2017

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