Organization
EYE SURGEONS AND PHYSICIANS OF ST LOUIS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK HARTSTEIN MD (OWNER)
(314) 469-1122
Entity
Organization
Contact information
Practice address
3454 MCKELVEY RD, BRIDGETON, MO 63044-2533
(314) 469-1122
(314) 822-6281
Mailing address
2315 DOUGHERTY FERRY RD, SUITE 101, SAINT LOUIS, MO 63122-3383
(314) 469-1122
(314) 822-6281
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R1168
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180024506
MEDICARE RAILROAD
MO
05
—
201539103
—
MO
01
—
2112
BCBS
MO
Enumeration date
05/22/2008
Last updated
11/25/2008
Update your record
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