NPIMap

Organization Active NPI

Complete Eye Care, Inc.

  • Ophthalmology Physician
  • Saint Louis, MO
National Provider Identifier
1275539173
Registry record updated Dec 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
COMPLETE EYE CARE, INC.
Practice address
9890 Clayton Rd
Suite 200
Saint Louis, MO 63124-1685
Phone
(314) 395-9613
Fax
(314) 395-9621
NPI assigned
Jun 24, 2005
Last updated
Dec 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Jean Tychsen
Title
Office Manager
Phone
(314) 395-9613

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MO Primary

Addresses

Primary practice location

9890 Clayton Rd
Suite 200
Saint Louis, MO 63124-1685

Mailing address

9890 Clayton Rd
Suite 200
Saint Louis, MO 63124-1685
Phone (314) 395-9613

Other practice location 1

121 Hunter Ave Ste 102
Saint Louis, MO 63124-2082
Phone (314) 721-1140

Other names 1

  • Clinical Ophthalmology, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070510000434 MO Part B Supplier - Clinic/Group Practice 7618073446 Receives reassigned benefits from 4 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1034 S Brentwood Blvd
Ste 410
Saint Louis, MO 63117
Phone (314) 727-6716

9890 Clayton Rd
Ste 200
Saint Louis, MO 63124
Phone (314) 395-9613

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577145600000",
    "number": "1275539173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9890 CLAYTON RD",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631241685",
            "telephone_number": "314-395-9613",
            "fax_number": "314-395-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9890 CLAYTON RD",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631241685",
            "telephone_number": "314-395-9613",
            "fax_number": "314-395-9621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Hunter Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631242082",
            "country_code": "US",
            "telephone_number": "314-721-1140",
            "fax_number": "314-721-7703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMPLETE EYE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A",
        "authorized_official_last_name": "TYCHSEN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "314-395-9613"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical Ophthalmology, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Clinical Ophthalmology, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.