Organization
MIDWEST VISION CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANTAL H JACQUES O.D. (MANAGING MEMBER)
(314) 249-7446
Entity
Organization
Contact information
Practice address
6614 CLAYTON RD # 319, SAINT LOUIS, MO 63117-1602
(314) 249-7446
Mailing address
6614 CLAYTON RD # 319, SAINT LOUIS, MO 63117-1602
(314) 249-7446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2009016926
MO
Other
Enumeration date
07/10/2009
Last updated
08/20/2010
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