Organization
DOWNTOWN CLINIC OF OPTOMETRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MORIO MIYAMOTO O.D. (PRESIDENT)
(314) 231-0581
Entity
Organization
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
152W00000X
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
12/18/2006
Last updated
07/18/2008
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