Individual
DR. MORIO MIYAMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
720 OLIVE ST, SUITE 420, SAINT LOUIS, MO 63101-2338
(314) 231-0581
(314) 231-2690
Mailing address
720 OLIVE ST, SUITE 420, SAINT LOUIS, MO 63101-2338
(314) 231-0581
(314) 231-2690
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
T2320
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007673
MEDICARE PTAN
MO
01
—
0791940001
MEDICARE REGIOND/DMERC
MO
05
—
310753819
—
MO
Enumeration date
12/04/2006
Last updated
09/18/2008
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