MEDICARE: SUREVISION EYE CENTERS MIDWEST 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
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1699857912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUREVISION EYE CENTERS MIDWEST LLC

Provider Business Mailing Address
First Line	:	320 BROOKES DR
Second Line	:	SUITE 111
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-2736
Country	:	US
Telephone Number	:	314-726-5669
Fax Number	:	314-726-5109

Provider Business Practice Location Address
First Line	:	12101 WOODCREST EXECUTIVE DR STE 150
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-5050
Country	:	US
Telephone Number	:	314-921-2020
Fax Number	:	314-863-9977

Authorized Official
Title or Position	:	COO
Name	:	SHELLEY LYNN MIANA
Credential	:	COE
Telephone Number	:	314-726-5669

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/18/2023

Similar Medicare Providers

1851340152 — DR. TONYA K BOURN O.D.
Practice Location Address:

12101 WOODCREST EXECUTIVE DR STE 150
CREVE COEUR, MO
63141-5050

Practice Phone: 314-863-9966
Practice Fax:

1396748000 — MR. LAWRENCE A GANS M.D.
Practice Location Address:

12101 WOODCREST EXECUTIVE DR STE 150
CREVE COEUR, MO
63141-5050

Practice Phone: 314-863-9966
Practice Fax: 314-863-9977

1205406766 — MISS JESSICA L. WEIS OD
Practice Location Address:

12101 WOODCREST EXECUTIVE DR STE 150
CREVE COEUR, MO
63141-5050

Practice Phone: 314-863-9966
Practice Fax: 314-863-9977

1851444517 — SUREVISION EYE CENTERS MIDWEST LLC
Practice Location Address:

12101 WOODCREST EXECUTIVE DR STE 150
CREVE COEUR, MO
63141-5050

Practice Phone: 314-921-2020
Practice Fax: 314-863-9977

1285053439 — DR. NICHOLAS WILLIAM GILL MD
Practice Location Address:

12101 WOODCREST EXECUTIVE DR STE 160
SAINT LOUIS, MO
63141-5050

Practice Phone: 614-371-0814
Practice Fax:

1598543316 — KELSEY ABBOTT DPT
Practice Location Address:

555 NORTH BALLAS ROAD , SUITE 225
CREVE COEUR, MO
63141

Practice Phone: 314-997-8700
Practice Fax:

Directions to “SUREVISION EYE CENTERS MIDWEST LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.