Organization
DES PERES EYE SURGERY CENTER, LLC
Active
Other names
St Louis Eye Surgery and Laser Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELANIE KOFRON MHA (ADMINISTRATOR)
(314) 686-4200
Entity
Organization
Contact information
Practice address
12990 MANCHESTER RD, SUITE 103, SAINT LOUIS, MO 63131-1860
(314) 686-4200
(314) 686-4217
Mailing address
12990 MANCHESTER RD, SUITE 103, SAINT LOUIS, MO 63131-1860
(314) 686-4200
(314) 686-4217
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548399561
—
MO
01
—
P00461792
RAILROAD MEDICARE
MO
Enumeration date
03/05/2007
Last updated
08/12/2008
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