Individual provider Active NPI

Glory Ezinne Mgboji, MD

  • Ophthalmology Physician
  • Saint Louis, MO
National Provider Identifier
1508403205
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
2026012302 Issued in MO
Practice address
517 S Euclid Ave
Dept Opthalmology, 1St FL
Saint Louis, MO 63110-1007
Phone
(314) 362-3431
Fax
(866) 505-8818
NPI assigned
Dec 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 2026012302 MO Primary

Addresses

Primary practice location

517 S Euclid Ave
Dept Opthalmology, 1St FL
Saint Louis, MO 63110-1007

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-3431

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260622001446 MO Practitioner - Ophthalmology 9335612415

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Johns Hopkins University School of Medicine, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

660 S Euclid Ave
Saint Louis, MO 63110-1010

Hospital & facility affiliations

  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1508403205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-3431",
            "fax_number": "866-505-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 S EUCLID AVE",
            "address_2": "DEPT OPTHALMOLOGY, 1ST FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101007",
            "telephone_number": "314-362-3431",
            "fax_number": "866-505-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MGBOJI",
        "first_name": "GLORY",
        "middle_name": "EZINNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2026-07-07",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2026012302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "517 S Euclid Ave",
            "address_2": "Dept Opthalmology, 1st Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.