Organization Active NPI

Comprehensive Eye Care and Surgery Inc.

  • Ophthalmology Physician
  • Bridgeton, MO
National Provider Identifier
1417065129
Registry record updated Aug 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
2004001643 Issued in MO
Legal business name
COMPREHENSIVE EYE CARE AND SURGERY INC.
Practice address
12255 De Paul Dr Ste 360
Bridgeton, MO 63044-2513
Phone
(314) 739-9293
Fax
(314) 739-3968
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2014

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

Authorized official

Name
Dr. Theresa Ellen Jones, M.D.NPI 1053428771
Title
President
Phone
(314) 739-9293

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 2004001643 MO Primary

Addresses

Primary practice location

12255 De Paul Dr Ste 360
Bridgeton, MO 63044-2513

Mailing address

12255 De Paul Dr Ste 360
Bridgeton, MO 63044-2513
Phone (314) 739-9293

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050520000739 MO Part B Supplier - Clinic/Group Practice 3577504471 Receives reassigned benefits from 2 practitioners
Practice locations: Bridgeton, MO; Saint Peters, MO

National Provider Directory

National Provider Directory

Locations

12255 De Paul Dr
Ste 360
Bridgeton, MO 63044
Phone (314) 739-9293

12255 De Paul Dr
Ste 250
Bridgeton, MO 63044
Phone (314) 344-7770

300 Medical Plz
Ste 140B
Lake St Louis, MO 63367
Phone (314) 739-9293

5301 Veterans Memorial Pkwy
Ste 102
Saint Peters, MO 63376
Phone (636) 441-9293

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409270400000",
    "number": "1417065129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 360",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442513",
            "telephone_number": "314-739-9293",
            "fax_number": "314-739-3968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 360",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442513",
            "telephone_number": "314-739-9293",
            "fax_number": "314-739-3968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE EYE CARE AND SURGERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2014-08-29",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-739-9293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2004001643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; 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.