Organization
EYE & VISION REGENERATION GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD S. JARKA O.D. (PRESIDENT)
(636) 449-7400
Entity
Organization
Contact information
Practice address
219 CHESTERFIELD TOWNE CTR, CHESTERFIELD, MO 63005-1257
(636) 449-7400
Mailing address
219 CHESTERFIELD TOWNE CTR, CHESTERFIELD, MO 63005-1257
(636) 449-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2796
MO
152W00000X
Optometrist
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11513262
CAQH PROVIDER ID
MO
01
—
11839863
CAQH PROVIDER ID
MO
05
—
317930634
—
MO
05
—
319058400
—
MO
Enumeration date
05/29/2009
Last updated
05/29/2009
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