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NPI Code Detail

MEDICARE: STAR OPTOMETRY ASSOCIATES LLC

MEDICARE: STAR OPTOMETRY ASSOCIATES 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
1152W00000XOptometristTO 2896MO

General Provider Information

NPI Number : 1922140052
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAR OPTOMETRY ASSOCIATES LLC
Provider Business Mailing Address
First Line : 11750 LUSHER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63138-1103
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11750 LUSHER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63138-1103
Country : US
Telephone Number : 314-741-1111
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. MARK VEENHUIS
Credential : OD
Telephone Number : 314-741-1111
Provider Enumeration Date : 02/13/2007
Last Update Date : 01/18/2011

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Directions to “STAR OPTOMETRY ASSOCIATES LLC ” Practice Location

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