Organization
SOUTH COUNTY EYE CARE
Active
Other names
South County Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDI NICOLE POLK (ADMIN)
(314) 843-5800
Entity
Organization
Contact information
Practice address
13131 TESSON FERRRY RD #108, ST LOUIS, MO 63128
(314) 843-5800
(314) 843-5290
Mailing address
13131 TESSON FERRRY RD #108, ST LOUIS, MO 63128
(314) 843-5800
(314) 843-5290
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MDR9N88
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203015219
—
MO
01
—
MDR9N88
MO LICENSE #
MO
Enumeration date
10/04/2006
Last updated
02/19/2019
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