Preventative & Regenerative Eye Care, LLC
Organization Active NPI Optometrist · Manchester, MO
NPI 1154698702 · NPPES record last updated Nov 28, 2011
Key facts
- NPI
- 1154698702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- TO3376 (MO)
- Legal business name
- PREVENTATIVE & REGENERATIVE EYE CARE, LLC
- Practice address
- 1107 Brittany Parkway Dr
Manchester, MO 63011-4327 - Phone
- (636) 227-8591
- NPI assigned
- Nov 28, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Charles Edward Bruce, O.D.
- Title
- Optometrist
- Phone
- (636) 227-8591
Practitioners 2
-
Jamal James Fox, O.D.
-
Jeffrey Howard Jacob, O.D.
National Provider Directory
Locations
11900 Saint Charles Rock Rd
Bridgeton, MO 63044
Phone (314) 291-8110
201 Highlands Boulevard Dr
Manchester, MO 63011
Phone (636) 256-3285
10835 Saint Charles Rock Rd
Saint Ann, MO 63074
Phone (314) 291-8110
31 Troy Sq
Troy, MO 63379
Phone (636) 528-4444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | TO3376 | MO | Yes |
Addresses
Primary practice location
1107 Brittany Parkway Dr
Manchester, MO 63011-4327
Mailing address
1107 Brittany Parkway Dr
Manchester, MO 63011-4327
Phone (636) 227-8591
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609868140 | Medicaid | MO |
Other providers in Manchester, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.