Organization
NUCROWN, LLC
Active
Other names
Crown Optical
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES D. MATTHEWS (PRESIDENT)
(618) 462-9818
Entity
Organization
Contact information
Practice address
11615 OLIVE BLVD, SAINT LOUIS, MO 63141-7095
(314) 567-3884
(314) 567-3431
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(618) 462-9818
(800) 432-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2999
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295737294
NUCROWN, INC. NPI
MO
Enumeration date
09/17/2012
Last updated
04/21/2017
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