# DES PERES EYE SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Louis Eye Surgery and Laser Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548399561
- **Authorized official:** MS. MELANIE KOFRON MHA (ADMINISTRATOR)
- **Authorized official phone:** (314) 686-4200

## Contact information

- **Practice address:** 12990 MANCHESTER RD, SUITE 103, SAINT LOUIS, MO 63131-1860
- **Practice address phone:** (314) 686-4200
- **Practice address fax:** (314) 686-4217
- **Mailing address:** 12990 MANCHESTER RD, SUITE 103, SAINT LOUIS, MO 63131-1860
- **Mailing address phone:** (314) 686-4200
- **Mailing address fax:** (314) 686-4217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1548399561 | — | MO |
| 01 | — | P00461792 | RAILROAD MEDICARE | MO |