Organization
NUCROWN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY L SHORT (CREDENTIALING MANAGER)
(618) 462-9818
Entity
Organization
Contact information
Practice address
12601 OLIVE BLVD, SAINT LOUIS, MO 63141
(314) 878-4228
(314) 878-7747
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(618) 462-9818
(800) 432-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
T02999
MO
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
11/21/2014
Last updated
06/28/2018
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