Ofallon Optometric Clinic

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02240 Issued in MO

Legal business name

OFALLON OPTOMETRIC CLINIC

Practice address

409 S Main St
O Fallon, MO 63366-2532

Phone

(636) 272-3383

Fax

(636) 272-3381

NPI assigned

Feb 27, 2007

Last updated

Apr 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Martin M Shulman, O.D.

Title

Optometrist

Phone

(636) 272-3383

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1457487837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S MAIN ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662532",
            "telephone_number": "636-272-3383",
            "fax_number": "636-272-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 S MAIN ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662532",
            "telephone_number": "636-272-3383",
            "fax_number": "636-272-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OFALLON OPTOMETRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "SHULMAN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "636-272-3383",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "310754213",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.