MEDICARE: RED EYE, INC.

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	T02191	MO

General Provider Information

NPI Number	:	1629257852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED EYE, INC.

Provider Business Mailing Address
First Line	:	908 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1420
Country	:	US
Telephone Number	:	314-241-9410
Fax Number	:	314-241-5406

Provider Business Practice Location Address
First Line	:	9717 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1503
Country	:	US
Telephone Number	:	314-997-0002
Fax Number	:	314-241-5406

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. ANTHONY M ERKER
Credential	:
Telephone Number	:	314-997-0002

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	12/28/2020

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Directions to “RED EYE, INC. ” Practice Location

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