Individual
THEODORE K. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
675 OLD BALLAS RD STE 220, SAINT LOUIS, MO 63141-7083
(314) 997-3937
Mailing address
2021 MAPLEWOOD COMMONS DR, MAPLEWOOD, MO 63143-1003
(314) 860-2020
(314) 860-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02915
MO
Other
Enumeration date
06/01/2005
Last updated
01/02/2026
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