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Organization
SOUTH COUNTY EYE CARE
Active
Organization
SOUTH COUNTY EYE CARE
Active
Other names
South County Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDI NICOLE POLK (ADMIN)
(314) 843-5800
Entity
Organization
Contact information
Practice address
13131 TESSON FERRRY RD #108, ST LOUIS, MO 63128
(314) 843-5800
(314) 843-5290
Mailing address
13131 TESSON FERRRY RD #108, ST LOUIS, MO 63128
(314) 843-5800
(314) 843-5290
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MDR9N88
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203015219
—
MO
01
—
MDR9N88
MO LICENSE #
MO
Enumeration date
10/04/2006
Last updated
02/19/2019
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